Exam 4

Question 1

ferrous sulfate

Answer 1

iron deficiency anemia

Question 2

cyanocobalmin

Answer 2

pernicious anemia

Adverse: hypokalemia (muscle weakness, nausea, palpitations and paresthesias)

Question 3

cyanocobalamin or folic acid

Answer 3

megaloblastic anemia

Question 4

Folic Acid

Answer 4

folate deficiency in alcoholism

prevent neural tube defects in fetus

Question 5

Iron Dextran

Answer 5

IV or IM. Test dose 1 hr before full dose.
Monitor s/s anaphylaxis-rash, wheezing, hypotension
For IV-no faster than 50mg/min
For IM- 2-3in needle, Z-Track
Iron needed for RBC production-monitor Hgb, Hct and reticulocyte counts
Oral-staining teeth-mix with water or juice use straw rinse mouth after

Question 6

Factor VIII (Hemophilia A)

Answer 6

Adverse: allergic reaction
mild-rash/itching-diphenhydramine
anaphylaxis-diff breathing, swelling airway, hypotension-epinephrine
Can take COX 2 inhibitor (Celecoxib)
No COX 1&2 inhibitors (aspirin, naproxen, ibuprofen) can cause GI bleed and ulceration

Question 7

Desmopressin

Answer 7

Adverse: fluid retention with hyponatremia

Question 8

Alteplase

Answer 8

give less than 2 hr for MI and 3-4.5 hr for CVA/Stroke
MI-chest pain, L arm pain, diaphoresis, abnormal ECG
Adverse: bleeding, symptoms of stroke. If pt taking alteplase develops stroke symptoms its hemorrhagic or bleeding in brain. stop and administer aminocaproic acid

Question 9

Heparin

Answer 9

Adverse: bleeding/hemorrhage-hypotension, tachycardia, bruising, petechiae, hematoma & black tarry stools. Decreased RBC, Hgb & Hct
aTTP monitored-1.5-2x baseline
Protamine given to reverse heparin
Adverse: autoimmune reaction resulting in thrombocytopenia, if platelet below 100,000 stop and use non-heparin anticoagulant

Question 10

Warfarin

Answer 10

Monitor INR-therapeutic range 2-3

Signs bleeding: light-headedness, dizziness, hypotension, tachycardia, decreased RBC, Hgb & Hct

Question 11

Clopidogrel

Answer 11

Adverse: thrombotic thrombocytopenic purpura-early indication decreased platelets, ecchymosis and pinpoint purplish petechial rash
Increased risk bleeding with NSAIDs, alcohol and some herbal supplements (gingko biloba)
PPIs (omeprazole) decrease antiplatelet effect and increase risk blood clots

Question 12

Epoetin

Answer 12

Adverse: hypertension, seizures, stroke symptoms
monitor Hgb for effectiveness
dont give to cancer pt with Hgb above 10
Report Hgb above 12 or 1 g/dL or more increase within 2 weeks

Question 13

Filgrastim

Answer 13

Adverse: bone pain and fever
Monitor WBC for effectiveness
If WBC above 10,000 lower or discontinue dose unless Nadir hasnt passed
Dont give w/in 24 hrs cytotoxic chemo like topotecan

Question 14

Oprelvekin

Answer 14

Adverse: cardiac dysrhythmias (tachycardia), fluid retention (edema), conjunctival injection (red conjunctiva) and blurred vision
monitor platelets for effectiveness
continue until platelets over 50,000 but no more than 21 days
SubQ 4-6 hr after chemo, next chemo not for at least 2 days after injection

Question 15

Alprazolam

Answer 15

Adverse: drowsiness and inability to recall events (high doses and alcohol)
Stopping abruptly may cause withdrawal symptoms-insomnia, anxiety, tremors, diaphoresis, dizziness, panic, hypertension, seizures, paranoia and hallucinations
Taper over 1-2 weeks to decrease withdrawal

Question 16

Toxicity with IV benzodiazepine (diazepam)

Answer 16

May cause life-threatening sedation, hypotension, tachycardia, resp depression and cardiac arrest
Flumazenil reverses benzodiazepines
Diazepam IV causes burning and venous irritation-avoid small hand veins

Question 17

Buspirone

Answer 17

Start 2-4 weeks before tapering benzodiazepines (alprazolam) due to delayed effects of buspirone
can have paradoxical effect-anxiety, restlessness, insomnia
MAOI antidepressant (phenelzine) can cause HYN dont take within 2 weeks of busiprone

Question 18

Amitriptyline

Answer 18

Adverse: increase risk suicide esp children and adolescents
increased risk OD-life threatening dysrhythmias, confusion, seizures, anxiety, delirium and coma
For OD: gastric lavage and sodium bicarbonate for dysrhythmias
No more than 1 week supply to decrease risk OD

Question 19

Fluoxetine

Answer 19

adverse: serotonin syndrome-mental confusion, difficulty concentrating, fever, agitation, anxiety, hallucination, incoordination, hyperreflexia, excessive sweating and tremors
Other adverse: wt gain and hyponatremia-monitor wt weekly and Na periodically

Question 20

Venlafaxine

Answer 20

Adverse: HTN and wt loss due to anorexia
Taper over 2-4 weeks to avoid w/drawal
No MAOI (phenelzine) within 14 days bc increases the risk for serotonin syndrome

Question 21

Phenelzine

Answer 21

Adverse: hypertensive crisis in presence of tyramine-containing foods (chocolate, aged cheese and red wine). If occurs, IV phentolamine or sublingual nifedipine are administered

Question 22

Bupropion

Answer 22

Adverse: N/V, wt loss, insomnia, agitation, tremors, psychosis, hallucinations and delusions
Give w/ food to decrease N/V and wt loss
Used for prevention seasonal affective disorder and smoking cessation adjunct
Contraindicated: hx eating disorder, seizure disorder and head trauma

Question 23

Lithium

Answer 23

Adverse: goiter, hypothyroidism, polyuria
Lithium toxicity: nausea, muscle weakness, fine to coarse hand tremors, ataxia, confusion, seizures, coma and death
Low sodium can cause lithium toxicity
NSAIDs (except aspirin) increase risk for toxicity

Question 24

Chlorpromazine

Answer 24

Adverse: acute dystonia, parkinson-like syndrome, neuroleptic malignant syndrome and tardive dyskinesia

Question 25

Neuroleptic Malignant Syndrome

Answer 25

Muscle rigidity, high fever, VS instability, and loss of consciousness

Question 26

Tardive Dyskinesia

Answer 26

involuntary movements of tongue, face, limbs and trunk

Question 27

Parkinson-like Syndrome

Answer 27

muscle rigidity, tremors, sluggish movements, drooling and shuffled gait

Question 28

Acute Dystonia

Answer 28

Severe spasms of neck and body

Question 29

Risperidone

Answer 29

Cause extrapyramidal effects similar to chlorpromazine but less often
Adverse: wt gain, onset or worsening DM, increased cholesterol levels
Report: polyuria, polydipsia, severe spasms, parkinson-like symptoms, inner restlessness or ability to sit still

Question 30

Betaxolol

Answer 30

Beta blocker-can cause bradycardia, hypotension, bronchospasms or constriction of bronchioles (expiratory wheezing)
Report: slow pulse, fainting spells and wheezing

Question 31

Pilocarpine

Answer 31

Cholinergic agonist can cause: bradycardia, constriction of bronchioles and urinary urgency
Adverse: retinal detachment
Report: dark floaters, flashes of light and “curtain” pulled over part of vision in one eye

Question 32

Echothiophate

Answer 32

Cholinesterase inhibitor can cause: bradycardia, constriction of bronchioles and urinary urgency
Adverse: cataract development, opacity behind pupil when penlight shining in eye
Report decreased daytime and nighttime vision
Administer in evening 5 mins apart from other eye drops

Question 33

Pilocarpine and Echothiophate

Answer 33

Pupil constriction
Adverse: decreased visual acuity esp at night
Report: urinary urgency, slow HR or wheezing