Exam 3 Practice Test Flashcards
Parkinson’s
A young patient has just been diagnosed with mild Parkinson’s. What drug should the nurse expect as first line treatment?
A dopamine agonist like pramipexole (mirapex). Levodopa wears off in time, and younger patients can handle the SE.
The nurse is preparing to give a drug to reduce the wearing-off effect of levodopa. What is the drug, and when is the nurse preparing it?
Selegiline (Eldepryl) in the morning because of insomnia
A patient is on amantadine to reduce dyskinesias caused by levodopa. Which side effects should the nurse EXPECT?
- urinary retention
- orthostatic hypotension
- livedo reticularis
- CNS effects
- gambling
- urinary retention (anticholinergic)
- livedo reticularis (mottled discoloration)
- CNS effects
- -
- orthostatic hypotension is selegiline
- gambling is pramipexole
A patient with Parkinson’s is complaining of dry mouth. Which two drugs might the nurse expect to see in their chart?
- benztropine (Cogentin) is an anticholinergic
- amantadine is an antiviral
A patient with Parkinson’s was advised to avoid high-protein meals. What drug combination are they on?
Levodopa/Carbidopa – n/v is a huge side effect.
A patient with Parkinson’s is extremely agitated and is showing signs that they might become psychotic. Is the nurse surprised, and what do they avoid?
No – psychosis, anxiety, and agitation are known AE.
Avoid 1st gen antipsychotics like Haldol.
A nurse is preparing a patient’s first dose of donepezil for Alzheimer’s disease. They note that the patient is also on prozac. How does the nurse proceed?
Gives as planned; anticholinergics are the drug-drug for donepezil.
Which Alzheimer’s drug needs to be given late in the day?
donepezil (Aricept) due to bradycardia, fainting, falls
A caregiver for an Alzheimer’s patient asks for some Miralax to help their loved one poop. Which drug does the nurse expect to see in the patient’s chart?
memantine
donepezil is a cholinesterase inhibitor so has opposite of anticholinergic SE –> diarrhea
After starting a patient on memantine, they seem much more disoriented and complain of a headache. Is that expected or unexpected?
Expected – too much calcium has entered the neurons
A patient’s caregiver says they haven’t seen any improvement over the three days the patient has been on donepezil. Is that expected or unexpected?
Expected: low and slow, and a looooong (70 hour) half life
A patient reports sleep driving on zolpidem (Ambien). Which benzodiazepine would also be a sleep aid?
triazolam (Halcion)
A patient has a substance use history and insomnia. Which drug might be a good choice for a sleep aid?
zolpidem or hydroxyzine
A patient states that they skip their buspirone when they’re having a few glasses of wine since they only need it when they’re anxious. Does the nurse intervene?
Yes. It’s not for PRN use, and it doesn’t have an ETOH interaction.
A patient who has been given IV midazolam has a BP of 80/40. What does the nurse expect?
flumazenil admin over 15 seconds, repeat every minute
A patient with suicidal ideation states that their anxiety has gotten really bad. Can they have a benzo?
Nope, try buspirone for daily or hydroxyzine for PRN
A patient’s EKG shows a prolonged QT interval. Which anxiolytic does the nurse expect in the patient’s medication list?
long-term hydroxyzine
A patient with PTSD wants an anxiolytic. What does the nurse expect?
An SSRI – it’s the only thing proven to help.
A patient reports dry mouth with hydroxyzine and sips on grapefruit juice throughout the day. Is that okay?
Yep – dry mouth is expected, and it’s Buspar that has the grapefruit interaction.
A patient on phenytoin reports a rash. Okay?
NOPE – SJS/toxic epidermal necrolysis
Which AED should a patient tell their dentist about?
phenytoin
A patient receiving IV AED reports that their groin is itching. Which drug are they on?
fosphenytoin
A patient on carbamezepine comes in with an infection. What are the concerns?
- BM suppression
- drug interactions with lots of anti-infectives
A patient on valproic acid complains of nausea, anorexia, and abdominal pain. Which side effect is most worrying?
Hepatotoxicity/pancreatitis
A patient says: “I’ve had this weird eye thing since being on Gabapentin – is that a micro-seizure?”
Nope, it’s nystagmus
Should a nurse question benztropine for Parkinson’s for a patient with glaucoma?
Yep, it’s an anticholinergic
Which RA treatment plan might a patient choose during a pandemic?
NSAIDs and Glucocorticoids – avoid immunosuppression
A patient states: “Running is my life. I don’t want to give it up with RA.” Which drug categories might be a fit?
DMARDs reduce joint destruction
A patient on methotrexate wants to become pregnant. What should their RA drug plan be in this process?
Any of the other drugs
A patient is getting started on methotrexate. What should they do while they’re waiting for it to work?
treat with NSAID and take folic acid
A patient with a significant family history of cancer needs to start antirheumatic therapy. Which drugs might increase their risk of cancer?
DMARDs – methotrexate and etanercept
When should a patient with RA be tested for TB
before biologic DMARD (etanercept)
A patient with tophi started allopurinol and says, can’t you just switch me back to cholchicine? Why, and why can’t you?
Cholchicine is great for acute but doesn’t actually help reduce tophi.
A patient on allopurinol reports stomach upset. How should the nurse proceed?
Give as usual. It’s colchicine that’s the n/v problem.
A patient on colchicine reports that they’ve increased their fluid intake using grapefruit juice. What’s wrong?
Grapefruit juice, and flushing is more important for allopurinol.
A patient on colchicine states: “It’s really helped my feet, but now my legs have been hurting. Is that part of gout too?”
Nope, look for rhabdo
In their first day of colchicine treatment, a patient states: “It feels like the colchicine you gave me a couple hours ago wore off. Can I have another dose?”
Nope, 1.2 mg loading, then 0.6 mg 1 hour later. Max 1.8/24 hours
A patient states: “I take my calcium carbonate in divided doses with my breakfast and dinner” What’s wrong
food interactions – whole grain cereals, spinach, rhubarb, swiss chard, beets, bran
A patient on alendronate says: “I sometimes wake up in the middle of the night and remember that I forgot my Fosamax. So I take it immediately on an empty stomach and go back to bed.” What’s wrong?
Esophagitis – remain upright for 30 minutes and take with a full glass of water.
Which osteoporosis drug helps with bone mets, and which can increase risk?
- alendronate helps
- teriparatide hurts
A patient on denosumab states: “I always take my vitamin D and calcium, and I schedule dentist appointments for after I’ve gotten my Prolia injection.” What’s wrong?
Osteonecrosis of the jaw
Which drug might be prescribed to a patient with severe osteoporosis?
teriparatide (Forteo) – rebuilds bones
A patient states “I’ll be off of my MAOI for a week before starting my antidiabetic drugs” correct?
Nope, 14 days – hypoglycemia
