Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharm II > Exam 2 (3/29) > Flashcards

Exam 2 (3/29) Flashcards

1
Q

Review s/s of toxicity related to alteplase (Activase)

A 
●	BLEEDING (can cause a serious GI bleed)
●	Angioedema
●	Hypotension
●	Recurrence of VTE
●	Anaphylaxis and fever 
●	Cholesterol embolization
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Know the administration technique of enoxaparin (Lovenox)

A

● Administer subQ in a prefilled syringe
● One-time use syringe
● Do NOT expel the air bubble from the syringe before administering, Administer the air bubble in the pre-filled syringe
● Monitor for excessive bleeding and bruising

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Review the therapeutic levels of PT and INR in regards to warfarin (Coumadin) therapy

A

● PT Normal Levels: 11-13 seconds
○ PT Therapeutic Levels: 18 seconds to 24 seconds
● INR Normal Levels: 1.1 or below
○ INR Therapeutic Levels: 2.0-3.0 with average of 2.5 KNOW THIS
■ For those with recurring clots 2.5-3.5 with an average of 3.0

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Identify AE’s of heparin induced thrombocytopenia

A 
●	pt has a platelet count that continues to drop significantly with increased thrombi 
○	Type I
■	Gradual reduction in platelets
■	Heparin therapy can generally be continued. 
○	Type II
■	Acute fall in number of platelets (more than 50% reduction from baseline)
■	Discontinue heparin.
○	Clinical manifestations
■	BLEEDING RISK
■	Thrombosis that can be fatal.
■	Bruising
■	Petechiae
■	Hematomas
■	black/tarry stools
■	Calf pain 
■	Tenderness 
■	Swelling
■	Shortness of air
●	 Toxicity:
○	 Discontinue heparin immediately – give antidote
○	Antidote to heparin is IV protamine sulfate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Review contraindications for antilipemic drugs

A 
●	Try non drug means for cholesterol levels for 6 months before drug is considered
●	High cholesterol… over 300 (more at risk for coronary heart disease)
●	Allergy
●	pregnancy
●	liver disease
●	elevated liver enzymes
●	Cirrhosis
●	gallbladder disease
●	Interventions:
○	Baseline liver function
○	Obtain CPK if muscle pain occurs
○	Dietary patterns, exercise, tobacco
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Know patient teaching for gemfibrozil (Lopid)

A

● Treats type III, IV, and V hyperlipemia
● May increase the risk for gallstones so avoid fried, fatty foods
● Can cause GI discomfort, N/V/D
● Must attempt lifestyle changes for 6 months before beginning therapy
● Need to have periodic liver function labs done

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Identify AE’s of atorvastatin (Lipitor)

A 
●	Myopathy (rhabdomyolysis)
●	GI disturbances
●	Headache
●	Rash
●	Dizziness
●	blurred vision
●	Fatigue
●	insomnia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Know contraindications for atorvastatin (Lipitor)

A

Drug allergy
● Pregnancy
● liver disease
● elevated liver enzymes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Know AE’s of albumin

A

● Impaired coagulation

● bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Review indications of sodium chloride

A

● Hypovolemia, dehydration
● Manage F & E imbalances
● Promote urinary flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Know contraindications for the use of potassium

A

● Hyperkalemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Review contraindications for thyroid replacement drugs

A

● Recent MI
● Drug allergy
● Adrenal insufficiency
● Hyperthyroidism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Know the time length of when therapeutic effects occur for thyroid replacement drugs

A

● Takes several weeks for therapeutic effects to be seen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Identify important teaching to the client prescribed thyroid replacement drugs – levothyroxine (Synthroid)

A

● It has a long half life, so once a day dosing… oral or IV
● Take it at the same time everyday, before breakfast (empty stomach- wait at least 30 minutes)
● Therapeutic effects take several weeks to occur
● Do not switch generic and brand name
● Dose in mcg (easy to make dosage mistake)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Review the instructions/teaching provided to clients who receive radioactive iodine-131.

A

● CONTAGIOUS WHEN RECEIVING TREATMENT!!
● Can contaminate others: saliva, urine
● Avoid sexual contact, sleeping in same bed as others, having close contact with children or pregnant women, and sharing utensils/cups.
● Contraindicated during pregnancy & lactation (cannot conceive for 6 months after treatment)
● Usually only on it for a short period of time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Know the major adverse effects of antithyroid drugs – propylthiouracil (PTU) – and how a nurse should monitor for these adverse effects.

A

● Upset stomach: dose with meals
● Agranulocytosis: low WBC
○ Fever, sore throat, unusual bleeding, skin breakdown
○ monitor CBC at baseline and periodically there after
○ Stop therapy if seen
● Liver and bone marrow toxicity
● Propylthiouracil (PTU)- 2 weeks of therapy needed before symptoms improve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Understand the rationale as to the importance of tapering off the dose of corticosteroids.

A

● Adrenal suppression can happen
○ Adrenal glands naturally secrete hormones, but once you take corticosteroids your adrenal glands stop making as much- this leads to addison’s crisis
○ Tapering off = waking adrenal glands back up

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

how to properly prepare and administer parenteral (IV) methylprednisolone (Solu-Medrol).

A

● Push on top to break the seal
● Mix the powder and solution a little bit
● Break off small top piece and clean with alcohol swap
● Shoot air into the vial and then draw back what you need
● Get rid of air/air bubbles and administer
give over 30 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Know the adverse effects associated with corticosteroid/adrenal drugs.

A

● Most important: moon face, hyperglycemia and psychosis, adrenal suppression
● Glaucoma
● cataracts
● Increased risk of infections, especially with common bacterial, viral and fungal microorganisms
● Thinning bones (osteoporosis) and fractures
● Thin skin, bruising and slower wound healing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Know the adverse effects of fludrocortisone (Florinef) and which types of clients it could be contraindicated in.

A 
●	Adverse effects: r/t water retention
○	Heart failure
○	HTN
○	Increased intracranial pressure
●	Contraindicated: systemic fungal infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Know the indications of use for proton pump inhibitors

A

● Erosive esophagitis
● GERD
● Ulcers in the stomach: Duodenal and gastric ulcers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Know the adverse effects of long term use of proton pump inhibitors

A

● Osteoporosis: get regular bone density screenings to monitor for bone loss
● C. diff
● Pneumonia
● Magnesium depletion

23
Q

Know the correct timing of administration of sucralfate (Carafate)

A

● Give 4 times a day on empty stomach
○ 1 hour before usual 3 meals and again at bedtime
● Do not give antacids within 30-60 minutes of administration
● Take all other meds 2 hours before administration

24
Q

Review client education regarding contraindications for misoprostol (Cytotec)

A

● Given orally 4 times a day with meals while patient is taking NSAID therapy
● Confirm nonpregnant state before starting
○ Teach women of childbearing age to use contraception during drug therapy
● Monitor for severe diarrhea and abdominal pain
● Monitor for excessive menstrual pain or midcycle bleeding

25
Q

Identify contraindications of laxative use

A

● Bulk forming: Esophageal or GI obstruction, fecal impaction, dysphagia, N/V, appendicitis, undiagnosed abd pain
● Stool softener: GI obstruction, perforation, concurrent use of mineral oil, fecal impaction, N/V, undiagnosed abd pain
● Stimulant: Children younger than 1 year, GI obstruction/perforation, anal or rectal fissures, ulcerated hemorrhoids, fecal impaction, ileus, undiagnosed abdominal pain

26
Q

Review nursing interventions related to antidiarrheal opiates

A

● Give hard candy
● Give them water
● Monitor for lightheadedness when walking
● Recommend lowest dose possible for the shortest time possible
● Monitor for anticholinergic effects
○ Dry mouth, urinary retention/constipation, less sweating, increased HR, dilated pupils, blurred vision
● Monitor urinary elimination patterns
● Loperamide (Imodium A-D)
○ Initial dose of 4 mg, follow each loose stool with 2 more mg. Do NOT exceed 16mg/day
○ Stop after 48 hours if diarrhea persists
● Diphenoxylate w/ atropine:
○ Treat overdose with naloxone (Narcan)
○ Atropine in high doses can cause unpleasant effects- so this discourages recreational use

27
Q

Review instructions/teaching for a client prescribed psyllium (Metamucil)

A

● Take 1-3 times daily with at least 8 oz of fluid- very important
● Taking before meals may reduce appetite
● Expect soft, formed stools 1-3 days after beginning therapy
● Monitor I&O and bowel function
● Monitor for severe diarrhea and dehydration

28
Q

Understand the indications for use of docusate (Colace)

A

● Constipation
● Prevention of fecal impaction
● Straining during defecation
● Painful elimination of hard stools

29
Q

Know the timing after administration of each laxative prototype that a client should expect a bowel movement

A

● Bulk forming: 1-3 days
● Stool softener: several days
● Stimulant: 6- 24 hours, suppository is 15 minutes-1 hour

30
Q

Review the correct administration/timing of IV ondansetron (Zofran)

A

● Give IV push dose up to 8 mg over 2-5 mins
● 30 mins before end of surgery
● Administer 30 mins before chemo and 4-8 hours later

31
Q

Know adverse effects of prokinetic drugs: metoclopramide (Reglan)

A

● sedation, dry mouth, diarrhea, extrapyramidal symptoms (dystonia, tremor, akathisia, parkinsonism, tardive dyskinesia)
○ FALL RISK
○ Monitor for diarrhea and dehydration
○ Water, gum, and hard candy for dry mouth
● Delayed gastric emptying

32
Q

Know adverse effects of antihistamines: dimenhydrinate (Dramamine)

A 
●	Sedation, drowsiness, dizziness
○	FALL RISK
●	anticholinergic effects
○	Dry mouth, retention, blurry vision, dilated pupils, increased HR, less sweating 
■	Watch bowel and elimination patterns
33
Q

Review instructions/teaching for a client prescribed scopolamine (Transderm Scop)

A

● Adverse effects – dry mouth, urinary retention, constipation
● Use gloves to administer and to take off
● Apply behind ear
○ Wash & dry area before applying
● Discontinue after 72 hours
● Recommend applying 4 hours prior to anticipated exposure to N/V

34
Q

Review how to properly and safely administer promethazine (Phenergan) IV

A

● Severe tissue damage can occur if given mistakenly intraarterial
● Dilute in at least 10 mL of fluid when giving IV
● Discontinue use if burning or pain occurs with IV administration

35
Q

Know the similarities and differences between water-soluble and fat-soluble vitamins

A

● Water soluble: Vitamin B1, B2, B3, B6, B12, C
○ Dissolve in water
○ Easily excreted in urine
○ Daily intake is necessary
○ Very rare to reach toxic amounts
● Fat soluble: Vitamin A, D, E, K
○ Dissolved in fat
○ Stored longer in liver and fatty tissues
○ Daily intake NOT needed unless deficient
○ Excreted via feces
○ Can reach toxic levels

36
Q

Identify the indications for calcium supplementation

A

● Calcium is needed for our bones and teeth.
○ treatment or prevention of calcium depletion
○ osteomalacia
○ hyperphosphatemia
○ osteoporosis in older adults
○ mostly women
○ muscle cramps
○ pregnancy and lactation
○ children.
● Give oral dose 1-3 hours after meals

37
Q

Know adverse effects of vitamin B2

A

● AE: Large doses can cause a yellow/orange discoloration of urine. Almost like a highlighter color.

38
Q

Know the drug interactions of vitamin B6

A

● Interaction: Levodopa
○ When taking it with levodopa it can reduce the activity of levodopa. Levodopa is a Parkinson’s medication, so it can result in worsening Parkinson symptoms.

39
Q

Review teaching/education for the client prescribed ferrous sulfate (Feosol)

A

● Ferrous sulfate (Feosol)= PO form
○ Do not crush or chew
○ Dilute liquid form, but not in milk because calcium can decrease the absorption of iron, the best liquid is orange juice.
○ Give through a straw and then rinse mouth after as this can stain the teeth.
○ Educate the patient that they may have black tarry stools when taking an iron supplement. Let them know that this is normal. We also see black tarry stools with a GI bleed, so we need to know if they are taking an iron supplement.
○ Doses will be 300 mg 2-3 times a day, we want to spread the doses evenly across waking hours (maximizes production of RBC’s).
○ Provide hard candy or gum after taking the liquid form.
○ Iron toxicity symptoms: nausea, abdominal pain, vomiting, dizziness, hypotension, headache, coma, shock, seizures.
○ The tablets look like M&Ms and taste like sugar so we must keep these away from children or it can cause iron overdose and peds poisoning deaths.
○ Give on empty stomach for best absorption, but can be given with food to decrease GI upset

40
Q

Identify the indications for use of vitamin B12

A

● Pernicious anemia: lack of intrinsic factor; vitamin B12 deficiency

41
Q

Identify the adverse effects of vitamin B12

A

● Major adverse effect: hypokalemia

● Diarrhea

42
Q

Review IV administration of folic acid (vitamin B9)

A

● IV form must be given SLOW (over 30-60 seconds) or add to an IV fluid infusion.
● Obtain baseline serum folate, Hgb, Hct, RBC and reticulocyte count
● Encourage daily intake of foods high in folate (green veggies, liver, some breakfast cereals, lentils)
● Teach patients to expect flushing and warmth following IV administration, yellow/orange discoloration of urine.

43
Q

Understand the MOA of erythropoietic growth factor: epoetin alfa

A

● Stimulates the production of RBC’s in the bone marrow.
● Used commonly with kidney disease, preoperative anemia, chemotherapy.
● It mimics our own body’s production of epoetin, helping us raise our hemoglobin and stimulating red blood cell production.
● Black Box Warning: Increased risk for cardiovascular events, this is why it is contraindicated in patients with uncontrolled HTN.
● It is not a quick fix, its onset of action is days to weeks.

44
Q

Understand nursing actions and monitoring needed to administer TPN

A

● Central line or PICC used.
● Change tubing every 24 hours
● Watch for hyperglycemia, may need insulin replacement.
● Used for prolonged periods of time (longer than 7-10 days)
● AE:Most are associated with the use of the central vein for delivery.
○ Greater potential for infection
○ Serious catheter-induced trauma and related events.
○ Greater chance for metabolic complications such as hyperglycemia due to more concentrated volumes of nutritional supplements being delivered.
● Assessment:
○ Thorough nutritional assessment:
■ Weekly and daily food intake
■ Weight and height
○ Ask about any nutritional concerns:
■ Weight gain or loss
■ Nausea, vomiting, anorexia, loss of appetite
○ Consult with registered dietician to identify nutrients missing in patient’s diet
○ Total body metabolic rate, body mass index, and muscle mass may be assessed.
● Labs:
○ Total protein level, albumin level, BUN, RBC’s WBC’s, hemoglobin, hematocrit
○ Cholesterol level, electrolytes, lipid profile.
● Before giving Parenteral Nutrition:
○ Assess allergies
○ Determine appropriate solution (with help from a registered dietician)
○ Assess patient/caregiver knowledge of central line/peripheral line: provide education to prevent infection/phlebitis
● Nursing Interventions:
○ Check the patient for s/s of hyperglycemia frequently: polydipsia, polyuria, polyphagia, HA, N/V, dehydration, weakness
○ Insulin replacement may be needed with the increase in glucose intake
○ If parenteral nutrition is discontinued abruptly, rebound hypoglycemia may occur:
■ Prevent by providing infusions of 5% to 10% glucose or D5W/D10W
○ Monitor S/S of fluid overload
○ Measure I&O as ordered

45
Q

Review client positioning in bed and nursing actions with continuous nutritional feeding

A

● We want to keep the HOB elevated at least 30 degrees while feeding, pause feeding if laying patient flat. A side effect is dumping syndrome so we do not want to elevate them anymore.
● Before enteral nutrition:
○ Assess allergies
○ Assess cardiac and renal status (can a patient handle large amounts of fluid?)
○ Assess gag reflex, ability to swallow, bowel sounds
● Nursing Interventions:
○ Must have prescriber’s order BEFORE administering
○ Check for proper NG tube placement prior to each feeding
○ Aspirate gastric residual volumes BEFORE each feeding and BEFORE administration of each medication
○ Follow prescriber’s orders infusion rate
○ Change tubing for parenteral feedings each time a new bag is added to the infusion and every 24 hours.
○ Adverse effect of dumping syndrome may decrease absorption of phenytoin
■ Hold tube feeding 2 hours before and 2 hours after administration of phenytoin

46
Q

Know the adverse effects of PPN

A

● Iv used- watch for phlebitis (vein irritation or inflammation of a vein)
○ Can lead to loss of a limb if it is not treated appropriately
● Other AE’s: Fluid overload and avoid in patients with renal or heart failure.

47
Q

Review client teaching/education when prescribed oral contraceptives

A

● Black Box Warning: Cigarette smoking increases the risk for serious cardiovascular events and cardiovascular disease
○ Risk increases with age >35 and the number of cigarettes smoke!
● Ensure understanding of how to take the drug and what to do if they miss doses.
● Importance of taking it the SAME time every day!
● If you forget to take a birth control pill, take it as soon as you remember.
● If you don’t remember until the next day, go ahead and take two pills that day.
● If you forget to take your pills for 2 days, take two pills the day you remember and two pills the next day.
● Encourage smoking cessation!!
● Monitor BP and weight
● Assess for drug interactions

48
Q

Know contraindications for hormone replacement therapy drugs

A

● Estrogen- dependent cancers
● Undiagnosed abnormal vaginal bleeding
● Pregnancy
● Active thromboembolic disorder or history

49
Q

Review the nursing implications for uterine stimulants

A

● Pitocin: Induce or enhance labor
○ Nursing Implications:
■ Careful monitoring, can cause uterine rupture if not followed closely.
■ Assess and document BP, pulse, and respirations
■ Continuous fetal monitoring (fetal HR and contraction related fetal HR)
■ ONLY give IVPB so oxytocin is diluted and on an infusion pump
■ Report any abnormal changes in fetal HR
● Methergine: Prevents postpartum uterine atony and hemorrhage
○ Nursing Implications: Limit use in hypertensive patients
● Cervidil and Prepidil: Induce labor
○ Nursing Implications: Monitor for uterine hyperstimulation

50
Q

Know the indications for use of magnesium sulfate

A

● Preterm labor

● Pre-eclampsia and eclampsia

51
Q

Understand the proper administration instructions for alendronate (Fosamax)

A

● Do not crush or chew tablet
● Do not lay down after taking this medication… sit or stand for at least 30 minutes
● Take on an empty stomach with a full glass of water

52
Q

Review client teaching/instructions in regards to testosterone (Androderm, Androgel)

A

● Androderm
○ Transdermal patch
○ Mimic the normal circadian variation in testosterone concentrations, with maximum levels occurring in the early morning hours and minimum concentrations occurring in the evening
○ To be applied to back, stomach, upper arms, or thighs nightly every 24 hours
● Androgel
○ Topical gel
○ To be applied to upper arms and shoulders at the same time each morning
○ Avoid showering, bathing, or swimming for 2 hours after application

53
Q

Know adverse effects of tamsulosin (Flomax)

A

● Can cause hypotension:
○ Monitor BP
○ Advise clients to rise slowly from sitting to standing

54
Q

Know drug interactions for sildenafil (Viagra)

A

● Nitrates (do not take within 24 hours)

Pharm II (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions