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Pharm 2 > Pharm 2 final exam > Flashcards

Pharm 2 final exam Flashcards

1
Q

What are the labs to to monitor for a patient taking diuretics

A 
Electrolytes - Especially Potassium (3.5-5)
Sodium (135-145)
Blood Glucose
Uric Acid Levels
BUN/Creatinine - kidney function
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2
Q

nursing interventions for older adult patients taking diuretics

A

● Lower doses & gradually increase
● Change positions slowly > orthostatic hypotension
● Have alternate methods of urination available (bedside commode, urinal)

Monitor Potassium levels and dehydration
Hyperkalemia s/s: muscle twitch/cramp/paresthesia, irritability, reduced BP, EKG changes, Dysrhythmias, abd. cramping, diarrhea

Hypokalemia s/s: (A SIC WALT) Alkalosis, shallow resp., irritability, confusion, weakness, arrhythmias, lethargy, thready pulse, constipation

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3
Q

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

A

Mornings, avoid taking it at night

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4
Q

Pt teaching for digoxin (lanoxin)

A

● report S/S of toxicity ➢ confusion, convulsion, yellow/halo vision, anorexia, NVD, palpitations, headache, bradycardia

Hold if pulse <60 & call provider
Take consistently, don’t skip or double dose

● frequent labs drawn → electrolytes and digoxin levels
● LOW K+ or Mg → can INCREASE risk of toxicity

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5
Q

AE of milrinone (Primacor)

A

Ventricular dysrhythmias

Hypokalemia
Hypotension
Angina chest pain
tremeor
Thrombocytopenia
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6
Q

drug interactions of milrinone (Primacor)

A

furosemide into IV line > phlebitis***

  • other diuretics may cause hypovolemia & decrease cardiac filling pressure
  • digoxin > Additive inotropic ( increased force of contractions)
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7
Q

therapeutic effects of antidysrhythmic drugs

A

Regular HR
Improved regularity of rhythm
Improved CO

Decreased BP in HTN patient
Decreased Edema
Decreased Fatigue

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8
Q

patient teaching for adenosine (Adenocard)

A

Causes a brief moment of *asystole

Not for long-term use

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9
Q

indications for verapamil (Calan)

A

● Convert SVT to regular sinus rhythm, slow rate of atrial fibrillation and A-Flutter

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10
Q

AE’s of quinidine (Quinide)

A

Cinchonism (tinnitus, visual disturbances, HA, N/V)
tinnitus > Ringing in ears

GI
Hypotension
Ventricular dysrhythmias (w toxicity)
Arterial embolism

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11
Q

when to use nitrates (nitroglycerin) cautiously

A

For acute angina attack

sildenafil (Viagra) – increased risk for severe HoTN

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12
Q

what are the proper methods for storage of oral (PO) nitroglycerin

A

glass bottle, protected from heat, closed tight, don’t use more than 24 months after opening
Should not be left in a room where the temperature is warmer than 86* Fahrenheit – best in bathroom med cabinet

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13
Q

nursing interventions for correct administration of IV nitroglycerin

A

HA→ may give a mild analgesic to treat nitro HA
Monitor for Drug tolerance→ give lowest dose possible, tolerance develops quickly

Special dark tubing, pt on tele, infusion pump used, rapid acting

Monitor BP as it gets low

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14
Q

therapeutic INR values for the patient taking warfarin (Coumadin)

A

Normal 1.1 or below
Therapeutic = 2.0-3.0 c average of 2.5
For those c recurring clots 2.5-3.5 average of 3.0

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15
Q

antidote for warfarin (Coumadin) and heparin

A

Warfarin - Vitamin K

Heparin - IV protamine sulfate

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16
Q

administration of enoxaparin (Lovenox)

A

sub Q, Administer the air bubble, it is a prefilled syringe, rotate injection sites
2 inches from the umbilicus
o DON’T MASSAGE THE AREA AFTERWARDS

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17
Q

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

A

Fatal because clots can form

Triggers platelet aggregation and thrombi develop in the vessels

Acute fall in platelets risk of acute drop in WBC, RBC, and sudden bleeding, more than 50% from baseline, cannot continue therapy

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18
Q

patient teaching for clopidogrel (Plavix)

A

● Avoid ETOH
● Report – excessive bleeding, gastric irritation, easy bruising
● S/S of GI bleed = black tarry stools, rectal bleeding, abdominal cramping/ take with milk to reduce GI AE
● HA, weakness/numbness, vision changes, N/V, seizures

Stop before surgery

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19
Q

AE’s of atorvastatin (Lipitor)

A

Myopathy – leads to rhabdomyolysis
(muscle pain/soreness, cola-colored urine, fever, malaise)
hepatotoxicity
If pt develops this, therapy will be stopped

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20
Q

contraindications for antilipemic drugs

A

●Liver disease/elevated liver enzymes

Severe kidney/liver disease
Gallbladder issues→ Gemfibrozil
● pregnancy

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21
Q

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

nursing interventions with sedating antihistamines

A

● Take at bedtime – causes drowsiness and fall risk
● anticholinergic effects - sip on water or hard candy to combat
● interactions → CNS depressants

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23
Q

Antitussives > dextromethorphan (DELSYM) non-opioid indication

A

ᗘ Chronic NONPRODUCTIVE cough due to allergies or URI

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24
Q

Antitussives > CODEINE opioid

A

ᗘ Chronic NONPRODUCTIVE cough due to allergies or URI

ᗘ SHORT TERM use

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25
Q

Expectorant: guaifenesin (Mucinex) indication

A

used for productive cough r/t colds, URI, bronchitis, pneumonia

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26
Q

Expectorants ᗘ Acetylcysteine (Acetadote) indicaiton

A

ᗘ Bronchopulmonary disease
ᗘ Cystic Fibrosis
ᗘ Acetaminophen Overdose

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27
Q

priority patient education regarding acetylcysteine

A

● make sure pt can cough up secretions
● ↑↑ volume of secretions > available suction

● Sulfur/rotten egg smell
● Report difficulty breathing or worsening cough
● NO metal/rubber parts on spacer
Increase fluids

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28
Q

phenylephrine AE

A

○ Rebound congestion

○ Potential for abuse

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29
Q

codeine AE

A

○ CNS/Resp depression
○ Dizzy/Drowsy
○ N/V/C

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30
Q

theophylline pt ed

A

● AVOID: Caffeine, smoking, charcoal-broiled foods, high protein, low carbs
● DON’T dbl up missed doses
● scheduled, not PRN

Used for LT management of asthma, not a rescue inhaler

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31
Q

Beclomethasone (QVAR) pt ed

A

● use AFTER albuterol (beta 2 adrenergic afonist)
● scheduled, not PRN
● use SPACER → reduce oral candidiasis (thrush)
● rinse mouth immediately after use

not for acute attack

32
Q

theophylline therapeutic blood levels

A

5-15 mcg/ml

33
Q

montelukast (Singulair) indications

A

Remember Emily takes this for Exercise

Chronic asthma, exercise induced asthma (prophylaxis), allergic rhinitis

34
Q

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

A

Albuterol

35
Q

indications for oxybutynin (Ditropan)

A

used for urinary incontinence due to overactive bladder and neurogenic bladder

36
Q

therapeutic outcomes and indications for bethanechol (Urecholine)

A

● Treats urinary retention r/t surgery, post-childbirth, lack of neurologic innervation in the bladder
● ↑↑ urine voiding, ↑↑ GI motility, ↓↓ constipation

37
Q

contraindications for oxybutynin (Ditropan)

A

Angle-closure glaucoma, GI or GU obstruction

myasthenia gravis, active cardiac dysfunction

38
Q

Rapid Acting - Lispro

(humalog) onset

A

15 min

39
Q

Short Acting - Regular

(humulin) onset

A

30-60 min

40
Q

Intermediate Acting -

NPH onset

A

1-2 hrs

41
Q

Long Acting - Lantus

(glargine) onset

A

1-2hours

42
Q

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

A

Corticosteroids = increase the amount of insulin (hyperglycemic)

estrogen, diuretics, thyroid drugs, nonselective beta blockers.

43
Q

AE’s of metformin (Glucophage)

A

Lactic acidosis→ Hyperventilation, cold, clammy skin, muscle weakness, pain, malaise, dizziness, palpitations

GI upset (super common)
Vitamin B12 deficiency (long-term use).

● discontinue 24 hrs prior to IV contrast dye (both hard on kidneys)

44
Q

insulin handling and adminsitration techniques

A

● CLEAR before CLOUDY
● Protect from heat and light, do not freeze
● in fridge = good until expiration date on label
● Room temp or opened = about 1 month
● ROLL vials between hands prior to withdrawing dose → DONT SHAKE
● always check glucose BEFORE administering

45
Q

when to administer glucagon (GlucaGen)

A

For a pt in hypoglycemia and is unresponsive

▪ IV: D50w

▪ No IV: glucagon

46
Q

patient teaching for levothyroxine (Synthroid)

A

Therapeutic effects may take up to 6 weeks**

monitoring for hyperthyroidism TSH (low) (mcg)

● Take in AM on empty stomach, 30 - 60 min b4 breakfast
● do NOT switch brands
● REPORT: irritability, palpitations, excitability = TOXICITY
● NO iodine rich foods (soybeans, tofu, seafood)

47
Q

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

A

Monitor CBC & LFTs

● Monitor CBC & LFTs (bc of liver SE) at baseline and periodically after
● Monitor for indications of agranulocytosis, stop therapy if seen

TSH, T3, T4

48
Q

the therapeutic onset for levothyroxine (Synthroid)

A

6 weeks

49
Q

drug interactions for fludrocortisone

A

● Antidiabetic drugs: ⇡ blood sugar

● Non-K+ sparing diuretics: hypocalcemia + hypokalemia
● Aspirin: GI effects

50
Q

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

A

● Can increase blood sugar → can trigger or worsen diabetes - check BS often

● Elevate pressure in the eyes (glaucoma)
● immune suppression > avoid crowds
● DON’T STOP ABRUPTLY → adrenal crisis
➢ Suppress adrenal gland hormone production - s/s fatigue, loss of appetite, nausea and muscle
weakness
● cataracts
● Round face (moon face)

51
Q

contraindications for fludrocortisone

A

**CHF

● Cataracts
● Glaucoma
● Peptic ulcer disease
● Mental health issues
● Diabetes (Caution)
● Infection
52
Q

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

A 
● Baseline: BP, Hcg, Hct, erythropoietin
● Monitor BP in therapy
● Only give to cancer pt w/Hgb < 10 gm/dL
Hmgb (Men 14-17; Women 12-16)
Hct (Men 41%- 50%; Women 36%-48%)
53
Q

patient teaching for ferrous sulfate (Feosol)

A

PO (● give on EMPTY stomach)
● spread doses across waking hours
● take with citrus/Vit C to help with absorption > Can cause black stools (normal)

Liquid (● through straw to not stain teeth)
● rinse mouth after taking
● dilute it
Take with Vit C to increase absorption but never with milk/antacids

54
Q

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

A

potassium

55
Q

contraindications for epoetin alfa (Epogen)

A

● uncontrolled HTN
● some malignancies (↑ cancer cells accidentally)

Cancer without chemo
Iron deficiency anemia

56
Q

patient teaching for methotrexate (Trexall)

A

Decreases immune system: DO NOT GIVE WITH ACTIVE INFECTION

o Monitor CBC
o Lower dose for RA / can cause N/V
o Therapeutic effect 4-6 wks

bone marrow suppression
➢ ↓ WBC, ↓ RBC, ↓ platelets- high risk for infection
➢ stop dose + call dr.

S/S of liver toxicity: yellowing of the skin or eyes
s/s of infection (fatigue, chills, fever)
abnormal bleeding, bruising, petechiae, blood in vomit/stool ( indicating decreased platelets)

difficulty breathing or SOB
ulcerations of the mucous membranes of the mouth and tongue

Google - avoid sun light

57
Q

contraindications for etanercept (Enbrel)

A

Do not give to patients with active infection

Avoid giving live vaccines to patients taking this drug

58
Q

patient teaching for etanercept (Enbrel)

A 
● Takes up to 3 weeks
● protect from light
● rotate sites
● weekly subQ in thigh/arm/abdomen
● available in prefilled syringes
59
Q

interacting medications with enteral nutrition

A

● Antibiotics, corticosteroids, phenytoin

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

60
Q

nursing interventions with parenteral nutrition

A

● Monitor s/s of hyperglycemia* (PPP, HA, N/V, dehydration, weakness)
● Accu-checks and sliding scale insulin commonly ordered
● Monitor for s/s of fluid overload
➢ ▪ HTN, edema, SOB, wt gain, ascites, crackles
● If parenteral nutrition is discontinued abruptly, rebound hypoglycemia may occur
➢ Provide 5%-10% glucose or D5W/D10W
● Measure I&O

61
Q

adverse effects of PPN, TPN, and enteral nutrition

A

Enteral Nutrition
● GI intolerance (diarrhea), dumping syndrome, risk for aspiration pneumonia
● *Dumping syndrome = nausea, weakness, sweating, palpitations, syncope, sensations of warmth, diarrhea will occur within 30 min - a few hours after tube feeding admin

PPN:
● *Phlebitis - inflammation of the veins
● risk for Fluid overload

TPN:
● Infection
● *Hyperglycemia

62
Q

contraindications for conjugated equine estrogen (Premarin)

A 
● Estrogen dependent cancers
● Undiagnosed abnormal vaginal bleeding
● Pregnancy (Category X)
● Active/history of thromboembolic disorder
● Smoking

don’t have premarital sex so you can’t be pregnant or have vaginal bleeding

63
Q

alendronate (Fosamax) contraindications:

A 
● Esophageal dysfunction
● Difficulty swallowing - dysphasia
● Serious kidney impairment
● Hypocalcemia
●inability to sit or stand 30 min after administration **
64
Q

priority nursing assessment and monitoring with the use of oxytocin

A

Can cause uterine hyperstimulation > lead to uterine rupture
● If uterine hyperstimulation syndrome occurs =➢ turn on side, stop infusion & administer O2
● Assess and document:
➢ BP, pulse, and respirations of mother
➢ Continuous fetal monitoring (fetal HR and contraction related fetal HR)

Only give IV PiggyBack (IVPB) so oxytocin is diluted and on an infusion pump

65
Q

priority nursing interventions with tamsulosin (Flomax)

A

o Monitor BP w/ 1st dose

o OH - sitting to standing slowly

66
Q

drug interactions with Viagra

A

● Nitrates (do not take within 24 hours) – causes Hypotension
● Grapefruit juice

67
Q

patient education with testosterone in the topical gel form

A

● Avoid: showing, bathing, or swimming for 2 hours after application
● To be applied to upper arms and shoulders at the same time each morning.
● Watch out for skin-to-skin transfer (especially to pregnant women)

68
Q

how to dose/administer other medications with sucralfate (Carafate)

A

● Give 4 times a day, 1 hour before usual 3 meals and again at bedtime
● No antacids within 30 min of administration
● take on an empty stomach
o Physical interference w/ absorption of other drugs: take 2 hrs prior

69
Q

patient education with proton pump inhibitors

A

● take 30-60 min BEFORE eating breakfast on empty stomach
● therapeutic effects → take a few days ➢ NOT for immediate relief
● long term therapy → can cause osteoporosis ➢ routine bone scans, ↑↑ calcium and vit D, do wt bearing exercises
● limit drug to lowest dose & shortest duration possible (8 wk MAX)

70
Q

adverse effects of each antacid
Aluminum (Amphojel)
Magnesium (Milk of Magnesia)
Calcium (TUMS)

A

● Aluminum (Amphojel): constipation, hypophosphatemia (low phosphate levels in blood)
● Magnesium (Milk of Magnesia): Diarrhea, don’t give to kidney failure
● Calcium (TUMS): Constipation, don’t give to kidney failure

71
Q

the timing of BM after taking laxatives (know for each type of laxative)
psyllium (Metamucil)
docusate sodium (Colace)
bisacodyl (Dulcolax)

A

psyllium (Metamucil) > 1-3 days after beginning therapy

docusate sodium (Colace) > 1-3 days after beginning therapy (soften passage of stool)

bisacodyl (Dulcolax) > PO - 6-12 hours
15-60 minutes after rectal suppository therapy

72
Q

patient education with Metamucil

A

●Take orally 1-3 times daily with at least *8 oz of water, Mix powdered forms with *8 oz of fluid and drink immediately
● Taking before meals may reduce appetite
● Expect soft formed stools 1-3 days after beginning therapy; not an immediate fix

73
Q

contraindications for use of laxatives

A 
● Esophageal or GI obstructions
● Fecal impaction
● Dysphagia
● N/V
● Undiagnosed abdominal pain
74
Q

adverse effects for Zofran

A

● Persistent headache*

● Dizziness and diarrhea

75
Q

patient teaching in regards to Scop Transderm patch

A

*Discontinue after 72 hours
*recommend applying 4 hrs prior to anticipated N/V
*Use gloves to administer and take off
● Apply patch behind the ear; wash and dry the area before application

Anticholinergic effects→ cant see, pee, spit, shit: monitor

Pharm 2 (3 decks)

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