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Pharmacology > Exam 4 > Flashcards

Exam 4 Flashcards

1
Q

What kind of drug is aspirin

A

Cox 1 and 2 inhibitor

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2
Q

what does Cox 1 enzyme do?

A

platelet aggregation, kidney function, stomach acid and mucous production

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3
Q

what does cox 2 enzyme do?

A

pain, inflammation, heat

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4
Q

What are the indications for aspirin?

A

headache, reduce fever, pain relief, decrease platelet aggregation, low dose protection

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5
Q

What aspirin is given to prevent MI’s and ischemic stroke?

A

81 MG enteric coated baby aspirin

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6
Q

If our client is taking aspirin for headache/ fever, what dose would they receive?

A

325 mg

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7
Q

what are other names for aspirin?

A

acetylsalicylic acid, ASA

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8
Q

Drug interactions for aspirin?

A

warfarin absorption increases (increases risk of bleeding), alcohol increases risk of gastric irritation/bleeding, GHerbs: garlic, ginger,gink,ginsing, feverfew

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9
Q

Contraindications of aspirin?

A

s/s of bleeding, s/s of hemorrhagic stroke, signs of hearing loss, surgery within 7 days

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10
Q

What are signs and symptoms of bleeding?

A

petechiae, purpura, coffee ground emesis, dark tarry stools, hematuria, increased bruising

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11
Q

Adverse effects of aspirin?

A

nephrotoxicity, bleeding, renal impairment, salicylism, Reye’s syndrome, teratogenic

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12
Q

Symptoms of salicylism?

A

tinnitus, dizziness, headache, fever, altered mental status, sweating

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13
Q

what is Reye’s syndrome?

A

when a child/adolescent has a viral infection and takes aspirin

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14
Q

Symptoms of Reye’s syndrome

A

liver damage, hypoglycemia, CNS damage

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15
Q

What to do if our patient has salicylism?

A

cool with tepid water, correct electrolyte imbalances, give bicarb to correct acidosis, hemodialysis, give activated charcoal to decrease absorption, gastric lavage

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16
Q

Nursing interventions for aspirin?

A

monitor bleeding, take with food due to GI upset, increase fluid to reduce renal impairment, stop one week before procedures, do not crush enteric coated, inform parents about Reye’s syndrome, do not administer if platelets less than 150 thousand, inform about G herbs

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17
Q

What drug should we inform children and adolescents take instead of aspirin?

A

acetaminophen

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18
Q

What drugs are NSAIDs?

A

ibuprofen, naproxen, indomethacin, ketorolac, diclofenac, meloxicam

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19
Q

How do NSAIDs and aspirin differ?

A

same effects except NSAIDs do not offer MI protective properties

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20
Q

What properties do all NSAIDs have in common?

A

analgesic, anti-inflammatory, antipyretic properties

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21
Q

contraindications of NSAIDs?

A

bleeding, renal and liver dysfunction, drinking alcohol

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22
Q

If we have a patient report to the ED with acute CP, what dose can we give them?

A

4 chewable aspirin 81 mg

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23
Q

Indications of NSAIDS

A

moderate pain, fever, tendonitis, sunburn, rheumatoid arthritis, osteoarthritis, naproxen primarily treats migraines

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24
Q

Side effects of NSAIDs

A

nausea/vomiting

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25
Q

adverse effects of NSAIDs

A

GI ulcers/bleeding, nephrotoxicity, hepatotoxicity, prolonged bleeding (can be intended effect as well)

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26
Q

What are the black box warnings for NSAIDs?

A

risk for cardiovascular event, GI bleeding

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27
Q

NSAIDs can cause worsening ____ _____

A

heart failure (because NSAIDs impair renal function which causes sodium and water retention)

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28
Q

Ketorolac cannot be used longer than? Why is this

A

5 days due to high risk of kidney damage

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29
Q

Nursing interventions for NSAIDs

A

take with food and water/milk, increase fluids to flush kidneys, avoid alcohol to limit GI irritation, avoid G herbs, monitor s/s of bleeding, monitor s/s of stroke/MI, do not crush enteric coated tablets, limit use of ketorolac, expect H2 blocker or PPI

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30
Q

Why are NSAIDs sometimes given with H2 blockers or PPI?

A

decreases risk of a GI ulcer

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31
Q

What are special considerations we should make for our older adults on NSAIDs?

A

start low and go slow, monitor renal function, increase fluids

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32
Q

What does DMARDS stand for?

A

disease modifying anti-rheumatic drugs

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33
Q

What drugs are DMARDs?

A

etanercept, infliximab, adalimumab, methotrexate

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34
Q

What are the indications for DMARDs?

A

slow degeneration of joints, slow progression of RA

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35
Q

DMARDs can cause _____ which increases the risk of?

A

immunosuppression ; infection

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36
Q

How long does it take for DMARDs to become therapeutic?

A

several months

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37
Q

Adverse effects of DMARDs (etanercept, infliximab, adalimumab)?

A

injection site pain, risk for infection, blood dycrasias, skin reactions such as Stevens Johnsons, heart failure

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38
Q

Symptoms of infections?

A

green sputum, high WBC, fever, chills, coughing, sore throat, etc

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39
Q

Nursing interventions for DMARDs (etanercept, infliximab, adalimumab)?

A

stop if reaction occurs at injection site, monitor for skin reactions such as blisters (from Stevens Johnson with flu-like symptoms), monitor s/s of heart failure (edema, SOB), monitor CBC and blood dyscrasias (bleeding, bruising, fever, anemia), monitor s/s of infections

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40
Q

Adverse effects of DMARD methotrexate?

A

infection, hepatotoxicity, bone marrow suppression, ulcerative stomatitis, fetal death (pregnancy category x)

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41
Q

Nursing interventions for DMARd methotrexate?

A

s/s of an infection, RFTs, LFTs, s/s of hepatotoxicity (abdominal pain, jaundice, N/V), advise patient to take folic acid, monitor for stomatitis, take with food, advise patient to be on birth control

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42
Q

With bone marrow suppression, we should monitor our clients for?

A

bleeding, infections, anemia

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43
Q

Why should those on methotrexate take folic acid?

A

reduces hepatotoxicity

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44
Q

What is stomatitis?

A

inflamed and sore mouth

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45
Q

Patients on DMARDs should avoid what type of vaccines?

A

live virus

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46
Q

How should nurses check for infection before starting our client on DMARDs?

A

do full review of systems and tuberculosis test

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47
Q

What are the anti-gout medications?

A

colchicine, allopurinol, probenecid

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48
Q

What are the indications for colchicine?

A

acute attack

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49
Q

How can colchicine be administered?

A

0.6 mg, wait one hour, another 0.6 mg(this is the max dose)

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50
Q

What causes gout?

A

increased uric acid

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51
Q

Indications for allopurinol?

A

non acute attack, used to lower uric acid (urate)

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52
Q

Indications for probenecid?

A

inhibits uric acid reabsorption

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53
Q

Clients with gout should avoid foods high in?

A

purine

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54
Q

examples of purine rich foods?

A

red meat, alcohol, seafood

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55
Q

Why should patients with gout increase fluid intake?

A

prevent kidney stones and encourage uric acid excretion

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56
Q

What is rhabdomyolysis, a side effect of anti-gout meds? What lab should we monitor in our patients?

A

muscle breakdown; creatinine kinase and urinalysis

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57
Q

Contraindications of anti-gout meds?

A

severe renal, cardiac, hepatic, or GI dysfunction

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58
Q

Patient teaching for anti-gout meds?

A

take with food, avoid grapefruit juice, avoid foods high in purine, avoid alcohol, avoid salicylates with probenecid, increase fluids, report s/s of infection, report muscle pain, metallic taste with allopurinol is normal

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59
Q

Allopurinol can cause what disease characterized by flu-like symptoms and blisters/rash?

A

stevens-johnson

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60
Q

Clients taking allopurinol should report what symptom?

A

rash

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61
Q

is the metallic taste experienced with allopurinol normal?

A

yes

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62
Q

What type of drug is acetaminophen?

A

non opioid analgesic

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63
Q

How does acetaminophen differ from NSAIDs and ASA?

A

has analgesic and antipyretic actions but no anti-inflammatory or antithrombotic action

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64
Q

Does acetaminophen cause GI upset?

A

no

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65
Q

Indications for acetaminophen?

A

fever and minor pain (such as musculoskeletal)

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66
Q

acetaminophen is the drug of choice for?

A

children and older adults

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67
Q

Symptoms of acetaminophen overdose?

A

N/V/D, sweating, abdominal pain, coma, liver damage up to 48 hrs after ingestion

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68
Q

Treatment for acetaminophen overdose?

A

administer acetylcysteine within 8 hrs of ingestion, gastric lavage within 4 hrs of ingestion

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69
Q

acetylcysteine can be given by?

A

nebulizer, oral, iv

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70
Q

What is the max daily dose of acetaminophen for healthy liver

A

4 g/day

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71
Q

What is the max daily dose of acetaminophen for unhealthy liver

A

2g/day

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72
Q

How to determine if a liver is healthy

A

normal AST and ALT tests

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73
Q

What are triptans?

A

drugs for headache

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74
Q

How to identify triptans?

A

end in -triptan

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75
Q

Indications of triptans?

A

headaches, migraines

76
Q

Mechanism of action for triptans

A

relieves pain by constricting blood vessels and suppressing inflammation

77
Q

How should we teach patients to take oral triptans?

A

take when migraines are first sensed, second dose 2 hrs later (do not exceed 100 mg in single dose and 200 mg total a day)

78
Q

How should we teach patients to administer subcutaneous triptans

A

how to administer, do not give more than 2 injections in 24 hours

79
Q

How should we teach patients to administer nasal spray triptans

A

administer as a single dose, can repeat in two hours

80
Q

Should triptans be avoided in pregnancy?

A

yes

81
Q

Indications for naloxone?

A

overdose symptoms: respiratory depression and respirations less than 10, cardiac arrest, neurotoxicity

82
Q

what drugs are opioid analgesics?

A

morphine sulfate, codeine, fentanyl, hydrocodone, hydromorphone, meperidine, methadone, oxycodone, oxymorphone, tramadol

83
Q

Indications for opioid analgesics?

A

acute or chronic pain

84
Q

Side effects of opioids?

A

sedation, dysphoria, hallucinations, nausea, constipation, decrease urine output, dizziness, orthostatic hypotension, pupillary construction, itching sensations

85
Q

Opioids can cause dysphoria. What does this mean?

A

depression, anxiety, restlessness

86
Q

Adverse effects of opioids?

A

respiratory depression, cardiac arrest, neurotoxicity (indicators of overdose) (bradycardia, hypotension, respiratory depression)

87
Q

those in opioid overdose can experience neurotoxicity, what are symptoms?

A

delirium, agitation, mild clonus

88
Q

Nursing interventions for opioids?

A

monitor vital signs before and during, monitor respiratory status and LOC, monitor urine output, monitor constipation, use cautiously during pregnancy/delivery/lactation, stop IV opioids before discharge, closely monitor patients taking drug, get pain level before and during,

89
Q

What is diversion? How can we determine if this is happening to our patient?

A

Someone not prescribed the opioids is taking them. Count pills and ask patient “tell me how you take your medication”

90
Q

What is the opioid overdose triad?

A

pin point pupils, respiratory depression, coma

91
Q

Drug interactions with opioids?

A

anti-seizure medications, other CNS depressants like alcohol and antidepressants,

92
Q

Patient teaching for opioids?

A

report symptoms of hypotension/ change positions slowly and dangle legs, increase fluid/fiber/exercise for constipation, teach how to use PCA pump, notify them tolerance can develop

93
Q

what is a PCA pump?

A

patient controlled analgesia

94
Q

a PCA pump must be ordered with?

A

naloxone

95
Q

What is basal/bolus CPA pump

A

basal is set dose, bolus is patient controlled

96
Q

Is anyone else allowed to press basal /bolus besides patient?

A

no

97
Q

if our patient is oversedated on a PCA pump we should?

A

discontinue the pump and notify provider

98
Q

If bolus is very frequently pushed we may need to?

A

increase basal dose

99
Q

What kind of drug is metoclopramide?

A

dopamine antagonist

100
Q

What is the mechanism of action for metoclopramide?

A

blocks dopamine receptors

101
Q

What are the indications for metoclopramide?

A

fix N/V caused by diabetic gastroparesis (slow emptying) or GERD

102
Q

What drug is psyllium husk?

A

bulk forming laxative

103
Q

What are the indications for psyllium husk?

A

decrease diarrhea in those with diverticulosis or IBS, control stool in colostomy and ileostomy promote defecation in older adults

104
Q

Patient teaching with psyllium husk?

A

increase fiber, fluids, exercise (2-3L)

105
Q

Can we give psyllium husk if our patient has difficulty swallowing? Why?

A

No ; increases risk of esophageal obstruction

106
Q

If our patient on psyllium husk does not increase fluids what could occur?

A

bowel obstruction

107
Q

What drugs are antihistamines/ anticholinergics?

A

hydroxyzine, scopolamine, doxylamine + pyridoxine (b6)

108
Q

Patient teaching for scopolamine?

A

place 4 hours before, leave on for three days, rotate ears during next dose

109
Q

What combination of antihistamines can pregnant patients take?

A

pyridoxine (vitamin b6) and doxylamine

110
Q

General side and adverse effects for antihistamines/anticholinergics?

A

can’t see, can’t pee, can’t spit, can’t poop. Dry eyes, sedation, drowsiness, fatigue

111
Q

General patient teaching for anticholinergics/antihistamines?

A

increase fiber, fluid, exercise for constipation. Suck on candy for dry mouth. Avoid heat because you do not sweat. Report vision changes

112
Q

Contraindications for antihistamines/anticholingerics?

A

glaucoma, BPH and urinary retention

113
Q

What kind of drug is promethazine?

A

phenothiazine and dopamine blocker

114
Q

Indications for promethazine?

A

nausea, vomiting, psychosis, schizophrenia

115
Q

Patient teaching for promethazine?

A

do not take with other CNS depressant like opioids and alcohol, report extrapyramidal symptoms: neck and face spasms, restlessness, anxiety

116
Q

What are the extrapyramidal symptoms seen in promethazine?

A

face and neck spasms, restlessness, anxiety

117
Q

What medications are stimulant laxatives?

A

bisacodyl, castor oil, Senna

118
Q

How do stimulant laxatives work?

A

stimulate intestinal mucosa to do peristalsis

119
Q

Patient teaching for stimulant laxatives?

A

avoid chronic use, do not take with milk and antacids, take at bedtime, reddish/brown urine is normal, increase fiber and fluids

120
Q

When should stimulant laxatives be taken?

A

at bedtime

121
Q

What is the surfactant laxative?

A

docusate sodium (stool softener)

122
Q

Mechanism of action for the surfactant laxative docusate sodium

A

increases water and electrolytes in bowel lumen to soften stool

123
Q

Indications for surfactant laxatives?

A

relieve constipation, prevent painful elimination, prevent straining, decreases risk for fecal impaction, promote defecation

124
Q

General contraindications for laxatives?

A

bowel obstruction, acute surgical abdomen, appendicitis, diverticulitis, ulcerative colitis

125
Q

Patient teaching to prevent constipation?

A

increase fiber fluid exercise

126
Q

What are the saline laxatives?

A

magnesium hydroxide, magnesium citrate

127
Q

Complications of saline laxatives?

A

absorb systemically leading to: dehydration, hypermagnesemia, sodium retention

128
Q

Patient teaching for saline laxatives?

A
129
Q

Nursing intervention for saline laxatives?

A

skin turgor, daily weights, I&O, monitor for edema, monitor renal function, monitor sodium and magnesium levels

130
Q

what drugs are osmotic laxatives?

A

polyethylene glycol (miralax), polyethylene glycol electrolyte solution (Golytely), lactulose

131
Q

Indications for polyethylene glycol? osmotic laxative

A

occasional constipation (2-4 days)

132
Q

Indications for polyethylene glycol electrolyte solution?

A

bowel prep for surgery/colonoscopy

133
Q

Indications for lactulose? osmotic laxative

A

prevention and treatment of encephalopathy (bring down ammonia levels)

134
Q

What are the antidiarrheals?

A

diphenoxylate with atropine, loperamide

135
Q

Indications for diphenoxylate with atropine?

A

provide symptomatic treament of diarrhea with opioids

136
Q

Is diphenoxylate with atropine a controlled substance?

A

yes

137
Q

Indications for loperamide ?

A

acute and chronic diarrhea

138
Q

Can our antidiarrheal medications be given if diarrhea is caused by organism? (ex. c-diff)

A

No

139
Q

What are antacids used to treat?

A

peptic ulcer disease and hyperacidity

140
Q

What are the different types of antacids?

A

aluminum, magnesium, calcium, sodium bicarbonate

141
Q

Side and adverse effects of aluminum antacids?

A

constipation, hypohosphatemia, hypomagnesemia, pregnancy category C

142
Q

Side and adverse effects of magnesium antacids?

A

diarrhea, hypermagnesemia and toxicity with impaired renal function

143
Q

Side and adverse effects of calcium antacids?

A

constipation

144
Q

Adverse and side effects of sodium bicarbonate antacids?

A

fluid retention

145
Q

Contraindications of sodium bicarbonate antacids?

A

those with HTN or HF

146
Q

Contraindications of magnesium antacids?

A

kidney dysfunction (avoid toxicity)

147
Q

Contraindications of aluminum antacids?

A

pregnancy

148
Q

What kind of drug is sucralfate?

A

mucosal protectant

149
Q

What is the indication for sucralfate?

A

gastric ulcer

150
Q

What is the mechanism of action for sucralfate?

A

coat the mucosa and protect the ulcer

151
Q

What evaluation tells us sucralfate is effective?

A

reduced pain

152
Q

What kind of drug is misoprostol?

A

mucosal protectant

153
Q

Indication for misoprotol?

A

NSAID induced ulcer

154
Q

Mechanism of action for misoprostol?

A

increase bicarbonate and mucin release. Reduces acid secretion which protects the lining of the stomach and helps ulcer repair

155
Q

Contraindications of misoprostol?

A

pregnancy category x, diarrhea, bleeding

156
Q

What are the H2 receptor blockers?

A

cametidine, famotidine (end in -tidine)

157
Q

Drug interactions of H2 Blockers?

A

warfarin, theophylline, lidocaine, phenytoin can cause toxicity

158
Q

Patient teaching for H2 Blockers

A

report s/s of respiratory infection, report gynecomastia and impotence, avoid alcohol, avoid smoking, avoid NSAIDs and aspirin, get rest, reduce stress, report s/s of bleeding, take on empty stomach

159
Q

Why should patients on H2 blockers, -tidines, report signs of respiratory infection

A

increased gastric pH from H2 blockers can cause increased bacteria –> risk of developing pneumonia

160
Q

How to recognize proton pump inhibitors?

A

end in -prazole

161
Q

What are the indications for proton pump inhibitors?

A

ulcers, erosive esophagitis

162
Q

Mechanism of action for proton pump inhibitors?

A

reduces acid secretions

163
Q

Adverse effects of proton pump inhibitors?

A

short term: headache, diarrhea, NV
Long term: pneumonia, osteoporosis, rebound acid hyper secretion, hepatotoxicity, hypomagnesemia

164
Q

Why do proton pump inhibitors put patient at risk of pneumonia?

A

increase ph leads to increase gastric bacteria which can spread to lungs

165
Q

We should be cautious of PPI in what patients?

A

high risk for pneumonia, dysphagia, and liver dx

166
Q

patient teaching for proton pump inhibitors

A

need bone density screenings, increase calcium and vitamin d, smoking cessation, stop alcohol and NSAIDs, notify s/s of bleeding, take in morning before eating

167
Q

How long does treatment for proton pump inhibitors typically last?

A

1-2 weeks (but up to 8)

168
Q

How to recognize iron?

A

ferrous in front

169
Q

Side effects/adverse effects of iron?

A

teeth staining, skin staining, go distress, including constipation, ,anaphylaxis, hypotension, toxicity in children

170
Q

patient teaching for iron

A

take on empty stomach if tolerable, rinse mouth after oral solution, black stool is normal, increase fiber fluid and exercise, avoid caffeine coffee tea dairy antacids, take with vitamin c

171
Q

Iron dextran and Iron sucrose require?

A

test dose and pretreatment with acetaminophen and diphenhydramine

172
Q

Indications for folic acid?

A

DNA, erythropoiesis, neural tube defects

173
Q

Patient teaching for folic acid?

A

if planning to become pregnant take folic acid (b9) and prenatal vitamin, maintain taking folic acid during pregnancy

174
Q

How many mcg of folic acid should pregnant women take a day

A

400 or 600

175
Q

What is overdose treatment for magnesiums sulfate?

A

calcium gluconate

176
Q

Normal ranges for potassium chloride?

A

3 - 7

177
Q

Signs of hypokalemia

A

muscle cramps/ weakness, inverted T wave, abnormal U wave, gi distress, cardiac issues

178
Q

Signs of hyperkalemia

A

paresthesia, GI issues, cardiac issues

179
Q

What is bethanechol used to treat?

A

“Big Bladder” - urinary retention NOT caused by obstruction

180
Q

Side effects/ adverse effects of buthanechol

A

cholinergic effects (SLUDGES)
overdose: increased gastric acid, hypotension, bradycardia, bronchoconstriction

181
Q

Indications of oxybutynin

A

Overactive bladder

182
Q

Indications of phenazopyridine?

A

relieve painful symptoms of UTI (does not reduce bacteria)

183
Q

Side effects of phenazopyridine?

A

red/orange urine, N/V, false positive glucose test on UA

184
Q

Adverse effects of phenazopyridine?

A

hepatitis, acute renal failure, hemolytic anemia

185
Q

Can bethanechol be given to someone with respiratory disorder?

A

No because cholinergic affects cause bronchoconstriction

Pharmacology (12 decks)

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