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Pharm 1 > Pharm 1 final exam SG Peer Completed > Flashcards

Pharm 1 final exam SG Peer Completed Flashcards

1
Q

What are the adverse effects and drug toxicity do in older adults?

A

Polypharmacy - Greater risk for medication errors (forgetting to take/taking too many times)

Drug polymorphism - use of multiple drugs to treat a single or multiple diseases.

the pharmacokinetics of specific drugs

Absorption slowed
Distribution decreased
Metabolism decreased
Excretion decreased

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2
Q

how medications/drugs are dosed for neonates and pediatrics?

A

mg/kg

2.2lb = 1kg

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3
Q

What is HIPAA and examples of violations in relations to pharmacology?

A

Privacy and Confidentiality

e.g. Don’t share prescription information with parties not approved by the client

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4
Q

What is a black box warning is and what it means to those that are prescribed a med with a black box warning?

A

Strictest FDA Warning

Indicates serious adverse effects

i.e. injury, serious illness or death

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5
Q

What are the 3 classes of FDA recall?

A

Class I: Most serious type. When a medication is removed from the market because there is a reasonable probability of serious adverse health problems or death.

Class II: Less severe. A medication is removed from the market because it may result in temporary or medically reversible health effects.

Class III: Least severe and is not likely to result in any significant health problems.

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6
Q

What is the rule regarding leading and trailing zeros?

A

No trailing zeros!! (Do not use 5.0 mg; use 5 mg instead)

ALWAYS use leading zeros!! (Do not use .25 mg; use 0.25 mg instead)

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7
Q

What are the ways to prevent medication errors

A 
KEY TO PREVENTION = REPORTING THE ERROR!
Checks and balances 
9 rights of medication administration
2 patient identifiers
Check drug references/pharmacist
Check every medication 3 times, twice on the MAR
Do not administer if you did NOT draw up or prepare yourself
Avoid abbreviations
Use generic names 
Check patient allergies
Never assume anything
Avoid verbal orders
Cross-check dosage with another nurse for high-risk medication
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8
Q

10 rights of medication administration

A
  1. Drug
  2. Dose
  3. Time
  4. Route/form
  5. Patient
  6. Documentation
  7. Client education
  8. To refuse
  9. Assessment
  10. Evaluation

Did Doug Take Ray Past Dark?
Can’t Tell Aunt Ellie!

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9
Q

What is the patient education for the use of baclofen (Lioresal)?

A

*SAFETY:
Do NOT stop abruptly (Black Box) - Rebound Spasticity
Dizziness - Fall Risk (CNS Depressant)
no driving
Take w/milk or food if GI upset
Monitor LoC
First dose tests for reaction - given intrathecally

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10
Q

At what stage in a patient’s hospitalization does discharge teaching begin?

A

Upon admission

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11
Q

What is the priority nursing interventions with propofol (Dipravan) in the peri-operative period?

A

Patient education: Pain/Burning on injection, can cause green urine
Patient must be ventilated!
Monitor blood pressure (Hypotension)
Monitor Respiratory Rate (respiratory depression)

Note: works for people with kidney and liver disease where other anesthetics might not

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12
Q

What is the contraindications of baclofen (Lioresal)?

A

Contraindication: Renal impairment

Watch for nephrotoxicity - BUN, creatinine, inputs/outputs

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13
Q

What is amphetamine (adderall) contraindications?

A

Severe, uncontrolled HTN

Glaucoma

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14
Q

What is amphetamine (adderall) adverse effects?

A

*speeds up everything!
Tachycardia, HTN, anxiety, insomnia, tremors, dry mouth, loss of appetite, weight loss, dysrhythmias at a toxic level

Weight loss in children

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15
Q

What is amphetamine (adderall) patient education?

A

avoid caffeine
Monitor weight and appetite of children
Drug holiday (e.g. don’t take on weekends to avoid tolerance buildup)
Don’t take past 4 pm, can cause insomnia

Black box warning - high potential for abuse
Taper off, do not stop abruptly

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16
Q

What is the MOA of carbidopa/levodopa?

A

MOA: carbidopa inhibits decarboxylase → lets levodopa get to the brain

Carbidopa protects levodopa, allowing it to get across blood/brain barrier, allowing levodopa to convert into dopamine

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17
Q

What is carbidopa/levodopa patient education?

A

may take up to 6 months to see results
Very important to take it at the same time every day
best to take on empty stomach
avoid high protein diet
Vitamin B6 reduces the effectiveness
On-Off and Wearing-off phenomenons
Orthostatic hypotension
Dyskinesia
Can cause darkened sweat/urine
Constipation is a big issue (hydration & stool softeners)
Watch for changes in moles/skin spots (can activate malignant melanoma)

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18
Q

What is opioid contraindications?

A

Pregnancy
Renal failure
Respiratory insufficiency
Gallbladder

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19
Q

What is the adverse effects of opioid?

A 
Respiratory depression 
Sedation
Dizziness
Urinary Retention
Constipation 
Nausea
Pruritus

Black Box Warning - Highly Addictive and Highly Toxic
Neonatal withdrawal symptom
Extreme resp. dep. when taken with Benzos

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20
Q

What is the nursing interventions of opioid?

A

Monitor - respiratory status (airway)

Antidote: naloxone (Narcan)
Acts almost immediately but wears off before opioids leave the system, so have additional doses available
Nasal at home, IV/IM in hospital
After administering for respiratory depression (e.g. post-surgery), pt. will need a new form of analgesic

If the patient is <8 respirations/min first action is to ASSESS
e.g. pt. might be asleep, monitor might not be working etc.

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21
Q

What is the contraindications of acetaminophen?

A

Liver disease
Careful with children
Alcohol

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22
Q

What is the adverse effects of acetaminophen?

A

Hepatotoxicity
Hypertension
Toxicity symptoms - N/V/D, abd discomfort, sweating

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23
Q

What is the proper dosing of acetaminophen?

A

FDA - 4000mg in 24hr
Tylenol - 3000mg in 24hr
Hospital recommendation 3500mg in 24 hr

*Patients with liver disease/or alcohol abuse - 2000mg in 24 hours

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24
Q

What are the adverse effects of Glucocorticoid?

A 
Moon Face (Cushing-like effects)
Truncal Obesity 
Hyperglycemia
Psychosis
Adrenal Suppression
Decreased Bone Density
Gastrointestinal Distress
Risk of ulcers
Decreased Immune Function
Increased Intraocular Pressure
Linked to Cataracts
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25
Q

What is the nursing interventions of glucocorticoid?

A 
Monitor: 
blood glucose
Physical/Emotional Stress
GI Bleeding
Infections
T-Score for bone density

Education:
Bone weakness possible
Tapering off slowly - If not can cause adrenal crisis
Adrenal glands are suppressed when taking, need to be ramped back up

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26
Q

What is the indication for use of over the counter medications?

A

Customer must be able to easily:

Diagnose condition
montior effectivness

benefits of correct usage must outweigh risks

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27
Q

What is safety profile of over the counter medications?

A

drug must have:
favorable adverse event profile

Limited interaction with other drugs
Low potential for abuse
High therapeutic index

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28
Q

What is the practicality of over the counter use?

A

Drugs must be:

Easy to use and monitor

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29
Q

The use of over the counter medications?

A

Can still interact
Can still be dangerous
Can delay appropriate diagnosis

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30
Q

safety considerations for the use of herbal supplements

A

Not FDA Regulated
Can have drug interactions - St. John’s Wort interacts with anything Serotonin-related
Kava potential liver toxicity (acetaminophen), Ephedra (CV & stroke risk), herbal supplements should be avoided by clients with CV diseases
Ginko, Garlic, Ginger can increase bleed risk
May not be safe for pregnant women, infants or children
Natural does not mean safe
Educate patient to monitor for reactions

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31
Q

Describe the role of the nurse in caring for clients with gene therapy and pharmacogenomics?

A

Patient education on risk of therapy not working - Adverse effects if wrong gene is activated

Different people react differently based on genetic makeup - This difference can not be predicted

Nurse acts as advocate for patients going through these therapies - report how drugs are affecting their clients

Nurses should stay up to date on new therapies to accurately monitor for side effects.

Some gene therapies can be passed on to future generations depending on if those genes are passed through sperm/egg
Germline passes to next gen
Somatic does not pass to next gen

32
Q

Describe how pharmacogenomics and gene therapy can impact prescribing and dosing medications?

A

Helps to predict patient responses to certain drugs based on their genetic makeup

Can determine dosing based on client’s metabolism

Can help predict adverse effects / interactions between drugs in a client

33
Q

patient teaching related to the use of selective serotonin reuptake inhibitors (SSRIs) - fluoxetine (Prozac)

A

Takes time to reach therapeutic levels

Serotonin Syndrome - Interacts with St. John’s Wort, MAOIs etc. to raise Serotonin to dangerous levels

Neuromuscular excitation = tremors, hyperreflexia
HTN, tachycardia, fever, sweating, flushed, ha
Altered mental state = confusion

Taper off - Antidepressant Discontinuation Syndrome 
Dizziness
HA/N/V
Aggression 
Mood disturbances
Suicidal tendencies
34
Q

patient teaching of AE/SE related to the use of selective serotonin reuptake inhibitors (SSRIs)

A 
GI Upset
Sexual Dysfunction
CNS Stimulation
Risk of suicidal ideation esp. when starting
Weight gain
35
Q

What is the nursing interventions of benzodiazepines - PAM & LAM

A

Antidote: flumazenil (Romazicon)

Monitor
ABCs
Cardiovascular Depression
Dizziness, drowsiness, fatigue, weakness
Fall Risk

*PRN - no schedule

36
Q

What is the patient teaching of benzodiazepines - Alprazolam (Xanax) - Diazepam (Valium)

A

Must be in writing due to amnesic effect

Coughing and Deep Breathing

37
Q

What is the nursing interventions of atypical antidepressants - bupropion (Wellbutrin)?

A 
Monitor: 
Dizziness
Tachycardia
Agitation
Seizure indications

Seizure precautions when staying in hospital
Low bed
Floor mats
Rails up

38
Q

What is the patient teaching of atypical antidepressants - bupropion (Wellbutrin)?

A

*Contraindicated for patients with history of seizure
*Lowers seizure threshold
Takes 4-6 weeks to reach max clinical effectiveness
Black Box - Risk for suicide up to age 24
Taper off
Works best when paired with therapy
Also indicated for smoking cessation

39
Q

What is the adverse effects / Complications of conventional antipsychotic medications haloperidol (Haldol) and chlorpromazine (Thorazine)?

A

Does not effectively treat negative symptoms - apathy, loss of joy, withdrawal

EPS - Extra Pyramidial Syndrome
Akathisia (painful muscle restlessness)
Acute dystonia (painful muscle spasms)
Tardive dyskinesia (lip smacking, tongue thrusting)

NMS - Neuroleptic Malignant Syndrome (can happen after 1st dose or after 20 years)
High fever
Unstable BP
rare but life threatening

Anticholergenic effects
Cardiac dysrhythmias
EPS/NMS can stay after stopping drug

40
Q

What is the nursing interventions of tricyclic antidepressants amitriptyline (Elavil)?

A
  • overdose is very LETHAL
  • don’t give a full month’s dose

toxicity: seizures & cardiac dysrhythmias

41
Q

What is the patient teaching of tricyclic antidepressants amitriptyline (Elavil)?

A

interacts with MAOI’s
4-6 wks for full effect
LETHAL overdose

42
Q

Correct eye drop administration techniques

A
  1. wash hands
  2. apply gloves
  3. pull eyelid down
  4. put drop in bottom eyelid
  5. pt applies pressure to inner canthus (esp. beta blockers) for 60 sec
43
Q

Common adverse effects of all ophthalmic medications

A 
Blurred Vision
Myopia
Discomfort 
Photophobia
Adverse Effects local and limited to the eye
44
Q

Nursing assessment and interventions for clients with renal and hepatic dysfunction

A

Renal: BUN, Creatinine, Inputs/Outputs

Hepatic: Jaundice
LFTs: increased AST/ALT enzymes
abdominal pain where liver is
N/V

45
Q

What is the adverse drug reaction of pharmacologic?

A

Therapeutic effect too extreme

e.g. Antihypertensive drug lowering blood pressure too much

46
Q

What is the adverse drug reaction of idiosyncratic? *

A

ABNORMAL/UNEXPECTED response, often due to genetics

ex: hyperactivity with Benadryl

47
Q

What is the adverse drug of allergic reaction?

A

(hypersensitivity)

Involves immune response

hives, wheezing, itching, swelling

48
Q

What is medication error?

A

PREVENTABLE adverse drug event by patient or hc provider

may or may not cause harm

49
Q

What is Synergistic Reaction?

A

More of an effect together than they would individually

1+1=3

e.g. Tylenol & Ibuprofen

50
Q

Differentiate between objective and subjective assessment data

A

Objective is measurable or observable

Subjective is what the patient tells you

51
Q

What is the nursing interventions to the use of acyclovir (Zovirax)?

A

Topical - Wear Gloves
Can cause Burning, Headache, Nausea/Diarrhea

PO - risk of n/v/d
IV - risk of nephrotoxicity *
Monitoring BUN, Creatinine, I/O

52
Q

What is the patient teaching to the use of acyclovir (Zovirax)?

A

Avoid sexual intercourse with active lesions

Use condoms with inactive lesions - Can still spread even without active lesions

53
Q

Patient teaching related to the principles of antiviral therapy

A

Treats symptoms and can speed up remission but does not cure

Not for use with immunocompromised clients

54
Q

What is the adverse effects of amphotericin B (Fungizone) and how to prevent and mange them?

A

Pretreate with tylenol, antihistamine, antiemetics

Can be very hard on veins - Use a large vein - Ensure patency before admin

If there is an infusion reaction slow the infusion

Monitor for nephrotoxicity
BUN, Creatinine, I/O

SE/AE
○ fever/chills
○ nausea
○ hypotension
○ tachycardia
55
Q

What are the adverse effects of anti-tubercular - rifampin (Rifadin) & isoniazid (INH)?

A

isoniazid (INH)
DRESS - Drug reaction with Eosinophilia and systemic systems
Fever, Rash, Facial Edema, Lymphadenopathy

Causes B6 deficiency - can lead to peripheral neuropathy

rifampin (Rifadin)
orange/brown bodily fluids
Expected.

56
Q

What is the interaction of anti-tubercular - rifampin (Rifadin) & isoniazid (INH)?

A

Monitor hepatotoxicity

Jaundice, AST/ALT (LFTs)

57
Q

What is the patient teaching of anti-tubercular - rifampin (Rifadin) & isoniazid (INH)?

A

Must finish all of a very long (6 month) treatment

Reduces effectiveness of oral contraceptives

58
Q

What are the adverse effects of gentamicin?

A

Nephrotoxicity

Ototoxicity

59
Q

What is the nursing assessment of gentamicin?

A

Monitor for tinnitus

Monitor Kidneys

Given IV - can be yellowish but should never be cloudy

60
Q

What are the interventions for client who takes gentamicin?

A 
Monitor trough level
1mcg/mL = therapeutic level
2+ toxic
Take with food
Do not share IV lumen with other drugs
61
Q

What are the interventions of vancomycin (Vancocin)?

A

Trough level 15-20 mcg/mL
*Monitor for Ototoxicity - Tinnitus
*Monitor for Nephrotoxicity
BUN, Creatinine, I/O

62
Q

What is the patient teaching for vancomycin (Vancocin)?

A

Red Man’s Syn.
= flush face/ trunk, itchy, hives
take w food
labs drawn regularly

63
Q

What are the interactions to the use of metronidazole (Flagyl)?

A

*Alcohol & Lithium - Extreme vomiting interaction with alcohol
Can even interact with hand sanitizers/mouthwash etc.

Needs its own IV line
Monitor for dizziness, Headache, seizures

64
Q

What is the patient teach to the use of metronidazole (Flagyl)?

A

No alcohol

Take with food

65
Q

Patient teaching related to the use of metoprolol (Lopressor)

A

How to take own pulse/blood pressure - Hold if HR < 60

Do not stop abruptly - Can cause hypertensive crisis

For diabetics - Take blood glucose regularly - Can mask symptoms of hypoglycemia

Know signs of heart failure
Orthostatic Hypotension
Take with food

66
Q

What are the medication interactions to the use of captopril (Capoten)?

A

Aliskiren- risk of hypotn, hyperk, renal issues,

Antacids- decrease affect

ARBs- increase toxicity

Lithium- increase lithium levels

NSAIDs- decrease effects

K+ sparing diuretics, salt substitutes w/ K+ = hyperkalemia

67
Q

What is the patient teaching to the use of captopril (Capoten)?

A

Dry, non-productive cough
first dose effect - hypotension
Keep blood pressure log
Watch for too much potassium in diet

68
Q

What are the interventions to the use of valproic acid (Depakote)?

A

Monitor therapeutic range - 50-125mcg/mL

Monitor:
Pancreatitis - Abd. Pain, N/V, anorexia
Blood Dyscrasia / Bone Marrow Suppression - Watch for infections
Labs - CBC, Platelet, Liver, Renal
worsening depression/suicidal ideation
69
Q

What is the patient teaching to the use of valproic acid (Depakote)?

A

Seizure Medication

Education
No alcohol
No oral contraceptives

70
Q

Toxicity and patient response to medication related to the use of phenytoin (Dilantin)

A

Therapeutic range = 10-20mcg/mL

Infuse through IV slow
(toxicity with a fast infusion),
put patient on tele

Sleepiness can be sign of drug toxicity or nystagmus (rapid involuntary eye movements)
Cardiac issues - Dysrhythmias
increases CNS effects
avoid alcohol & Tylenol - risk of toxicity

71
Q

Prioritization interventions related to carbamazepine (Tegretol)

A

Contraindicated in pregnant women

Pt edu:
↓ OC effect
pill coating can show up in stool
take w. food
pills sensitive to moisture - store in dry place
bone marrow suppression → report signs of infx - fever, sore throat, chills

72
Q

What are the adverse effects related to carbamazepine (Tegretol)

A

Therapeutic range 4-12mcg/mL

hepatic/renal impairment
✓ LFTs, jaundice, abd pain, N/V
✓ BUN, creatinine, I&O’s
Anorexia = toxicity (draw blood to monitor) blood dyscrasias = ↓ levels

73
Q

Patient education related to adverse effects and interactions with donepezil (Aricept)

A

Take at bedtime due to drowsiness
Monitor for Bradycardia - Contact provider if < 60

Monitor for GI bleeds (tarry stools, blood in stool, coffee ground emesis)
No NSAIDS as those can cause bleeds
Anemia can be from GI bleeds

Take at regular intervals

74
Q

Medication interactions related to sumatriptan (Imitrex)

A

Drugs that ↑ Serotonin = SSRIs, MAOIs, St. John’s Wort (antidepressants) - Can cause serotonin syndrome
Neuromuscular excitation: tremors, hyperreflexia
Autonomic Nervous System dysfunction: ↑ BP, ↑ HR, fever, flushing, HA
Altered Mental Status: ↑ confusion

Vasoconstrictor - can increase risk of MI, Stroke, Coronary Artery Disease, Peripheral Artery Disease - Bad for ischemic conditions

75
Q

patient teaching related to sumatriptan (Imitrex)

A

● OTC & supplements can interact

● med works BEST in AURA phase

Pharm 1 (1 decks)

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