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Pharm 2 > Final Exam > Flashcards

Final Exam Flashcards

1
Q

Know which labs to monitor for a patient taking diuretics

A

*Potassium (3.5-5)
*Sodium (135-145)
Electrolytes
Blood Glucose
Uric Acid Levels
BUN/Creatinine

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2
Q

Review nursing interventions for older adult patients taking diuretics

A

Caution older adults d/t increased risk of fluid/electrolyte imbalances
Monitor s/s of hyperkalemia, hypokalemia, dehydration
➢ s/s hyperkalemia: muscle twitches, irritability, EKG changes
➢ s/s hypokalemia: muscle weakness, cardiac dysrhythmias, decreased motility
Change position slowly

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3
Q

Know when (times of day) to teach patients to take their diuretic drugs

A

Beginning of the day/ several hours before bed

NEVER right before bed

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4
Q

Review patient teaching for digoxin (Lanoxin)

A

*Toxicity→ Reports Nausea, loss of appetite, vomiting, HA, visual disturbances, heart palpitations
Frequent labs drawn → electrolytes and digoxin levels
● LOW K+ or Mg → can INCREASE risk of toxicity
Do not administer med if HR is <60bpm, call provider
Take at same time every day (don’t skip or double dose)

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5
Q

Know AE’s of milrinone (Primacor)

A 
*Ventricular Dysrhythmias > occur in 12% of clients
Hypokalemia
Hypotension
Anginal chest pain
Tremor
Thrombocytopenia
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6
Q

Review drug interactions of milrinone (Primacor)

A

Do not inject furosemide into IV line c milrinone as it will precipitate and cause phlebitis**
Concurrent use of diuretics may cause significant hypovolemia and reduced cardiac filling pressure
Additive inotropic effect with concurrent use of digoxin

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7
Q

Know therapeutic effects of antidysrhythmic drugs

A

Normal sinus rhythm
BP normal
Reduce dysrhythmias

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8
Q

Review patient teaching for adenosine (Adenocard)

A

Can cause short Asystole from short half life

Not for long term use

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9
Q

Know the indications for verapamil (Calan)

A

Convert SVT to normal sinus

Slow HR in A-Fib and A-Flutter

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10
Q

Review AE’s of quinidine (Quinide)

A 
*Cinchonism (tinnitus, visual disturbances, HA, N/V)
GI
Hypotension
Ventricular dysrhythmias
Arterial embolism
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11
Q

Identify when to use nitrates (nitroglycerin) cautiously

A

Viagra (Sildenafil) – increased risk for HoTN

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12
Q

Know the proper methods for storage of oral (PO) nitroglycerin

A

Good for up to 24 months

Glass bottle, away from heat/light – best in bathroom med cabinet

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13
Q

Review nursing interventions for the correct administration of IV nitroglycerin

A

Needs to be in special tubing – protect from heat/light
HA→ may give a mild analgesic to treat nitro HA
Monitor for Drug tolerance→ give lowest dose possible, tolerance develops quickly

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14
Q

Know therapeutic INR values for the patient taking warfarin (Coumadin)

A

Normal: 1.1 or below
Therapeutic: 2-3 (avg = 2.5)
➢ those with reoccurring clots 2.5-3.5 (avg = 3)

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15
Q

Know the antidote for warfarin (Coumadin) and heparin

A

Warfarin Antidote🡪 Vitamin K

Heparin Antidote🡪 IV protamine sulfate

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16
Q

Review the steps for the correct administration of enoxaparin (Lovenox)

A

*Administer air bubble in pre-filled syringe
Rotate sites
2 inches from the umbilicus
Aseptic technique

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17
Q

Review the complications that can occur in a patient with heparin-induced thrombocytopenia

A 
Fatal because clots can form 
Acute drop in platelet count = risk of acute drop in WBC, RBC, and sudden bleeding
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18
Q

Know patient teaching for clopidogrel (Plavix)

A 
*Report s/s of excessive bleeding (TTP)
Can take c food, 8 oz of water, or milk to reduce GI adverse effects
Report persistent GI pain
*No alcohol
Stop before surgery
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19
Q

Review AE’s of atorvastatin (Lipitor)

A

*Myopathy🡪 rhabdomyolysis

If pt develops this, therapy will be stopped

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20
Q

Know contraindications for antilipemic drugs

A

*Liver disease/elevated liver enzymes

Pregnancy

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21
Q

Review drug-drug interactions for gemfibrozil (Lopid)

A

Warfarin – increased risk for bleeding

Statin and fibrate – increased risk for myopathy

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22
Q

Understand nursing interventions with sedating antihistamines

A

Take at bedtime – causes drowsiness and fall risk
Anticholinergic effects (can’t see…)
Interactions → CNS depressants

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23
Q

Know indications for each type of antitussive/expectorant

A

Codeine🡪 used for suppression of non-productive cough r.t allergies or URI (opioid antitussive)
Dextromethorphan (Delsym)🡪 used to suppress non-productive cough r/t allergies or URI (Non-opioid antitussive)
Guaifenesin (Mucinex)🡪 used for productive cough r/t colds, URI, bronchitis, pneumonia (expectorant)
Acetylcysteine (Acetadote) 🡪 used for bronchopulmonary disease, CF, acetaminophen overdose

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24
Q

Know priority patient education regarding acetylcysteine

A

Increase fluids
Expect sulfur-like odor
Have suction available
No metal/rubber parts

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25
Q

Know adverse effects associated with phenylephrine and codeine

A

Phenylephrine - rebound nasal congestion, short term (3-5 days)
Codeine - CNS/Resp depression, constipation, N/V, dizziness

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26
Q

Understand patient education regarding theophylline and QVAR

A

Theophylline - NO char-broiled food, caffeine, high protein, low carb, scheduled not PRN (not rescue)
QVAR - use after albuterol, Scheduled not PRN, use spacer

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27
Q

Know therapeutic blood levels for theophylline

A

5-15 mcg/ml

28
Q

Know the indications for montelukast (Singulair)

A

Chronic asthma
Allergies
Before exercise
Allergic rhinitis

29
Q

Know which medication is used for an acute asthma attack or a “rescue” inhaler

A

Albuterol

30
Q

Know indications for oxybutynin (Ditropan)

A

Urinary incontinence

31
Q

Review therapeutic outcomes and indications for bethanechol (Urecholine)

A

Indicated for urinary retention r/t surgery,post-childbirth,lack of neurogenic bladder innervation.

Urinary voiding, increased GI motility, and reduced constipation

32
Q

Know contraindications for oxybutynin (Ditropan)

A

Angle-closure glaucoma, GI/GU obstructions, Myasthenia gravis, active cardiac dysfunction

33
Q

Know the onset of action for each type of insulin

A

Rapid Acting (Lispro)🡪 15 min
Short-Acting (Regular) 🡪 30-60 min
Intermediate (NPH)🡪 1-2 hrs
Long-acting (Lantus) 🡪 1-2 hrs

34
Q

Review drug interactions with insulin and other drugs (HINT: think insulin and corticosteroid drugs)

A

Corticosteroids cause hyperglycemia

35
Q

Know AE’s of metformin (Glucophage)

A 
*Lactic acidosis→ Hyperventilation, cold, clammy, mm weakness, pain, malaise, dizziness, palpitations
GI upset (super common)
Vitamin B12 deficiency (long-term use).
36
Q

Review proper storage, handling, and administration techniques of insulin

A

If stored in the refrigerator🡪 they are good until the expiration date on the vial
If stored at room temp🡪 they are good for 1 month
Clear before cloudy
roll vials don’t shake

37
Q

Know when to administer glucagon (GlucaGen)

A

Nonresponsive hypoglycemic pts

38
Q

Review patient teaching for levothyroxine (Synthroid)

A

Take in AM on empty stomach, take 30 min-1H before breakfast
Brand name vs generic matters
Therapeutic effects may take up to 6 weeks**
Monitor for hyperthyroidism

39
Q

Know which labs to monitor for the patient taking propylthiouracil (PTU)

A

TSH, T3, T4
Monitor CBC and s/s of agranulocytosis
*LFTs

40
Q

Review the therapeutic onset for levothyroxine (Synthroid)

A

6 Weeks

41
Q

Review drug interactions for fludrocortisone

A

Non-potassium-sparing diuretics (hypocalcemia and hypokalemia)
Aspirin (added GI effects, increased risk for PUD)
Antidiabetic drugs (reduce hypoglycemia effects, leading to elevated blood glucose)
Rifampin and phenobarbital-decreased effectiveness

42
Q

Know nursing considerations for corticosteroid drugs (HINT: think blood glucose levels)

A

Check blood glucose levels often

43
Q

Identify contraindications for fludrocortisone

A

Don’t abruptly stop
Heart Failure
Hypersensitivity

44
Q

Know what labs to monitor for a patient taking epoetin alfa (Epogen)

A

Hmgb (Men 14-17; Women 12-16)
Needs to be less than 10 in cancer patients
Hct (Men 41%- 50%; Women 36%-48%)
erythropoietin level

45
Q

Review patient teaching for ferrous sulfate (Feosol)

A 
PO
- spread doses across waking hours 
- give on EMPTY stomach 
- take with citrus/Vit C to help with absorption
Oral
- through straw to not stain teeth 
- rinse mouth after taking 
- dilute it
46
Q

Identify which labs to monitor for a patient taking vitamin B12 (cyanocobalamin)

A

K+

47
Q

Know contraindications for epoetin alfa (Epogen)

A 
Uncontrolled HTN 
some malignancies (↑ cancer cells accidentally) 
iron deficiency anemia
48
Q

Review the patient teaching for methotrexate (Trexall)

A

Bone marrow suppression

Can cause n/v

49
Q

Know contraindications for etanercept (Enbrel)

A

Do not give to patients with active infection

Avoid giving live vaccines to patients taking this drug

50
Q

Know patient teaching for etanercept (Enbrel)

A

Report s/s of infection immediately
No live vaccines
onset→ 1-2 weeks

51
Q

Know interacting medications with enteral nutrition

A

Antibiotics, corticosteroids, phenytoin

➢ Hold tube feeding for 2 hours before and after administering the drug

52
Q

Understand nursing interventions with parenteral nutrition

A

Watch for fluid overload
Hyperglycemia - Polyuria, polydipsia, polyphagia, HA, N/V
Accuchecks
D/C abruptly = rebound hypoglycemia = D5/D10

53
Q

Know adverse effects of PPN, TPN, and enteral nutrition

A

PPN🡪 phlebitis, risk for fluid overload
TPN🡪 infection, hyperglycemia
Enteral: GI intolerance, aspiration pneumonia risk, dumping syndrome

54
Q

Know contraindications for conjugated equine estrogen (Premarin) and Fosamax

A

Premarin: Estrogen dependent cancers, undiagnosed abnormal vaginal bleeding, pregnancy, active or hx of thromboembolic disorders, smoking
Fosamax: Esophageal dysfunction, difficulty swallowing, serious kidney impairment, hypocalcemia, inability to sit or stand 30 min after administration **

55
Q

Understand priority nursing assessment and monitoring with the use of oxytocin

A

Careful monitoring because it can cause uterine hyperstimulation syndrome which can lead to a uterine rupture
Turn on side and administer oxygen, stop infusion
Assess and document BP, HR, & RR of mother, as well as continuous fetal monitoring

56
Q

Understand priority nursing interventions with Flomax

A

Can cause hypotension, monitor BP, advise client to do slow position changes
Hold before eye surgery
Teach life-long therapy
Once daily at same time, 30 min after same meal***

57
Q

Know drug interactions with Viagra

A

Nitrates and grapefruit juice

58
Q

Understand patient education with testosterone in the topical gel form

A

To be applied to upper arms and shoulders at the same time each morning
Avoid showering, bathing or swimming for 2 hours
Watch out for skin-to-skin transfer

59
Q

Know how to dose/administer other medications with Carafate

A

Causes physical interference with absorption of other drugs = take other drugs at least 2 hours ahead**
Give 4x daily- 1 hr before usual three meals, and again at bedtime **
Take on empty stomach
Use with caution with renal failure/dysfunction
No antacids within 30 min of administration

60
Q

Know patient education with proton pump inhibitors

A

Take 30-60 min in morning, on empty stomach, once daily dosing (before breakfast)
May take a few days to relieve symptoms (not to be used for immediate relief)
Long term therapy can cause osteoporosis
Need to have routine bone density screening
Increase calcium and Vit D
Perform WBing exercises
Limit drug therapy to lowest dose and shortest duration possible, recommended taking up to 8 weeks

61
Q

Know adverse effects of each antacid

A

Aluminum hydroxide🡪 constipation + decreased phosphate
Magnesium hydroxide🡪 diarrhea, caution c kidney failure
Calcium carbonate🡪 constipation, caution c kidney failure

62
Q

Know the timing of BM after taking laxatives (know for each type of laxative)

A

Psyllium🡪 soft, formed stool 1-3 days after beginning therapy, not a quick fix
Docusate sodium🡪 stools will be softer 1-3 days after beginning therapy
Bisacodyl🡪 bowel movement will come 6-12 hours after beginning therapy, 15-60 min c suppository

63
Q

Understand patient education with Metamucil

A

Drink 8oz of fluid with each dose**

Taking before meals may reduce appetite

64
Q

Know contraindications for use of laxatives

A

Esophageal or GI obstructions, fecal impaction, dysphagia, N/V, undiagnosed abdominal pain

65
Q

Know adverse effects for Zofran

A

HA
Dizziness
Diarrhea

66
Q

Understand patient teaching in regards to Scop Transderm patch

A

Anticholinergic effects→ cant see, pee, spit, shit: monitor
Use gloves to administer and take off
d/c after 72 hours
recommend applying 4 hrs prior to anticipated N/V

Pharm 2 (2 decks)

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