Pharm Final Exam Flashcards
1
Q
What are the four main pharmacokinetic (PK) phase and what occurs during each phase?
A
🔶 Absorption.
* Movement of the meds into the blood stream via the (veins).
🔶 Distribution.
* Movement of the meds from the blood into the tissue and cells via the (Heart).
🔶 Metabolism
* Change in the drug structure (Liver)
🔶 Excretion
* Movement out of the body (Kidney)
2
Q
Define pharmacodynamics (PD) and explain how it differs from Pharmacokinetics.
A
- Pharmacodynamics - “This is how a drug works in the body.”
- Pharmacokinetics - “The movement of drugs.”
3
Q
How does proteins binding affect the distribution and action of a drug in the body?
A
- By changing the effective concentration of the drug at its site of action.
- By changing the rate at which the drug is eliminated,
4
Q
What is the first-pass effect and how does it influence the bioavailability of a drug?
A
🔶 These are meds that are metabolized in the liver after being absorbed into the portal circulation from the small intestines.
* Levothyroxine
* Esomeprazole
* Diphenhydramine (Benadryl)
5
Q
What are the key steps in the nursing process when administering medications?
A
- Assessment
- Analysis (or Nursing Diagnosis)
- Planning
- Implementation
- Evaluation
6
Q
List at least three patient identifiers that should be used when giving medications to ensure patient safety?
A
- The patient’s :-
* Name
* Birthday
* Assigned ID number (Medical Record number)
* Telephone number
* Photo ID
7
Q
When should medication reconciliation be performed?
A
- Medication reconciliation is done every time a patient is transferred from one level of care to another.
Eg. (ICU to Step down) or (Med surg to ICU) or (Admission and Discharge)
8
Q
Who does the Medication reconciliation?
A
- The Doctors do the reconciliation.
(The nurse only makes sure that the doctors have done it.)
9
Q
What are the common signs and symptoms of Anaphylaxis?
A
- Rash
- Hives
- Hypotension
- Blocking of the airway
10
Q
How do we manage Anaphylaxis in an emergency situation?
A
- Give epinephrine.
- Maintain the airway.
- Monitor the client very closely.
11
Q
Describe the typical Anticholinergic effects of certain medications?
A
- Anticholinergic medications interferes with the system making it hard for the body to enter the “Rest and Digest” mode.
- Can’t see
- Can’t spit
- Can’t pee
- Can’t defecate
12
Q
List the medications that cause Anticholinergic effects.
A
- Benztropine
- Trihexyphenidyl
- TCA
13
Q
What are the risk factors for Drug-induced hepatotoxicity and how can it be detected?
A
- They can be detected through signs and symptoms of Liver failure:- “JAUNDICE”
* Jaundice * Anorexia * Upper abdominal pain * Nausea / Vomiting / Diarrhea * Dark urine * Increased need of sleep * Clay stool (Grayish) * Ecchymosis (Irritated skin) -
- They can be detected through the lab results:-
* AST
* ALT - The risk factors of Hepatotoxicity includes:-
* Liver Disease
* Alcoholism
14
Q
Explain the signs of CNS depression?
A
- Bradycardia
- Decreased respirations
- Extreme confusion/ memory loss.
- Nausea and vomiting.
- Poor judgment.
- Blue lips or fingertips.
- Irritability and aggression.
- Clammy or cold skin.
15
Q
What are the potential consequences of overdosing on CNS depressant drugs?
A
- Can decrease respirations or even stop the breathing.
- Can increase the risk of falling in older adults
- Decreased heart rate.
- Loss of consciousness
- Can leading to coma or death.
16
Q
What is Orthostatic Hypotension?
A
- Its when you move from a horizontal position to a vertical position, and gravity pulls much of the blood to the lower extremities.
17
Q
How can we manage Orthostatic Hypotension?
A
- Change positions slowly.
- Drink plenty of water.
- Wear support hose.
18
Q
Define polypharmacy and explain its potential risks, particularly for elderly patients.
A
- Polypharmacy - Is when older adults take alot of drugs (more than one).
- Potential risks for polypharmacy include:-
* Toxicity
* drug interaction
19
Q
How do age-related changes in pharmacokinetics affect drug absorption, distribution, metabolism, and excretion in geriatric and pediatric patients?
A
🔶 The aging process causes the liver and kidney function to decline.
- Naturally, this usually means dosages should be decreased.
🔶 The pediatric, their organs (Kidneys & livers ) are under developed, that affects the pharmacokinetics process.
20
Q
Explain the purpose of the Beers Criteria.
A
🔶 Beers Criteria
- Is a helpful resource that specifies which drugs are most dangerous to older adults and provides a succinct rationale (American Geriatrics Society, 2019).
21
Q
Describe the basic structure and function of a neuron.
A
- The neurons sending and receiving neurotransmitters (chemicals that carry information between brain cells.)
22
Q
Explain the role of synapses in neuronal communication.
A
- They connect neurons
- They help transmit information from one neuron to the next.
23
Q
Describe the process of neurotransmitter release, reuptake, and degradation.
A
🔶 Reuptake.
- This is where the neurotransmitters are sucked back inside the presynaptic terminal where they can be recycles for future use.
🔶 Degradation.
- The brain makes enzymes that break apart neurotransmitters.
24
Q
Explain the mechanism of action mechanism of action of selective serotonin reuptake inhibitors (SSRIs).
A
- These drugs, as their name states, are very selective.
- SSRIs only block serotonin reuptake pumps.
- This only increase levels of serotonin in the brain.
25
What is the typical time frame for antidepressants to start showing their full therapeutic effects?
* 1 - 4 weeks
26
Discuss the potential increased risk of suicidal thoughts and behaviors associated with using antidepressants, particularly in certain age groups.
- Suicide ideation is most common in children under 18 years.
27
What precautions should be taken when prescribing and monitoring patients on antidepressant therapy to minimize the risk of suicide?
* Avoid prescribing TCA.
* Make sure you TCA stay out of the hands of those tiny people that like to crawl around and stick everything in their mouth.
28
Why are TCAs considered to have a higher risk of overdose compared to other classes of antidepressants?
- The most serious problem with TCAs is that they can cause fatal heart dysrhythmias when overdosed.
29
What are the therapeutic effects of benzodiazepines, and what are their main indications for use?
* Muscle relaxant (for muscle spasms)
* Anticonvulsant (for Seizures)
* Sedative (relaxing) - (for Anxiety)
* Hypnotic (sleep-inducing) - (for insomnia)
* Anxiolytic (anti-anxiety) - (for Anxiety)
30
Describe the common adverse effects of benzodiazepines.
- CNS depression (Slurred speech, dizziness, Ataxia, Memory difficulties)
- Additive Effects (PT should avoid alcohol)
- Falls and Injuries (Avoid operating heavy machinery)
- Addiction Potential (Highly addictive)
31
Discuss the risk for addiction and dependence associated with benzodiazepine use, including the factors that may increase this risk.
- Benzodiazepines are highly addictive and withdrawal symptoms are extremely unpleasant.
- Benzodiazepines are meant for short-term use.
- Long-term users should avoid abrupt discontinuation.
32
Identify common drug interactions involving benzodiazepines and describe their potential consequences.
🔶 The common drug interactions involving benzodiazepines include:-
* Opioids.
* Alcohol.
🔶 Their potential consequences include:-
* Falls and injuries
* CNS depression
33
Compare and contrast the mechanism of action of benzodiazepines and Z-drugs (e.g., zolpidem, zaleplon, eszopiclone).
🔶 The mechanism of action of benzodiazepines (benzodiazepine1 & 2) incudes :-
* It decrease anxiety.
* Can stop seizure activity.
🔶 The mechanism of action of Z-drugs (benzodiazepine1) incudes:-
* It causes Sedation or sleep.
34
What are the risk factors for developing lithium toxicity, and how can they be minimized during lithium therapy?
🔶 Risk factors for developing lithium toxicity include:-
* Renal damage/impairment
* Exceeding the recommended dosage
* Low sodium diet
* Drug interaction
* Dehydration
🔶 To minimize dangerous fluctuations in lithium levels, clients should:-
* Maintain consistence amounts of sodium in their diets.
* Avoid excessive exercise (i.e., avoid extreme exercise and hot weather).
* Stay well hydrated (i.e., drink 8-12 cups of fluid per day).
35
Explain the relationship between sodium levels and lithium levels in the body, and how sodium intake or balance changes can affect the risk of lithium toxicity.
🔶 Kidneys can’t tell the difference between sodium and lithium (both are salts).
* So if a client eats an unusual amount of salt, the kidneys will try to get rid of all that salt. In so doing, they will also get rid of lithium.
🔶 The kidneys will try to hold onto sodium. In so doing, they will also hold onto lithium, causing levels to increase.
* If a client loses a bunch of sodium from dieting or sweating profusely
36
Describe the common signs and symptoms of lithium toxicity.
- Use the Mnemonic "SCAN"
- Sedation & slurred speech
- Course hand tremors
- Ataxia (incoordination) (being clampsy)
- Nausea, vomiting, diarrhea (persistent)
37
What is the relationship between clozapine use and the risk of neutropenia, and why is this side effect of particular concern?
- Clozapine causes Agranulocytosis
- The most significant of these is its link to the destruction of WBC.
- This can cause a severe infection that spreads through the bloodstream (septicemia).
38
Compare and contrast the typical side effect profiles of FGAs and SGAs, including the risks of extrapyramidal symptoms (EPS), metabolic side effects, and tardive dyskinesia.
🔶 FGA (First-Generation Antipsychotics)
* Higher risk of Extrapyramidal Symptoms
* Higher risk Neuroleptic Malignant Syndrome
* Higher risk of Tardive dyskinesia.
🔶 SGA (Second-Generation Antipsychotics)
* Lower risk of Extrapyramidal Symptoms
* Lower risk of Neuroleptic Malignant Syndrome
* Higher risk of Metabolic Syndrome
* Higher risk of Agranulocytosis
39
Discuss the importance of regular follow-up and growth monitoring in children receiving ADHD medications, including the assessment of height, weight, and overall growth patterns.
- CNS stimulants are strong appetite suppressants.
- This can cause unintended weight loss and growth suppression in children.
- To mitigate this problem, clients can take their medication during or after meals.
- Some prescribers may also recommend taking a break from the medication (drug holiday) on weekends or during the summer.
40
What strategies can be employed to minimize the risk of insomnia in patients taking ADHD medications?
- CNS stimulants can also cause insomnia.
- The prescriber may reduce the dose if a client is experiencing insomnia.
- It’s also important not to take these medications too late in the day (i.e., after 4 PM).
- They should be taken early in the day.
41
Explain the relationship between nonsteroidal anti-inflammatory drugs (NSAIDs) and the risk of gastrointestinal (GI) bleeding.
- All NSAIDs can cause damage to the stomach’s lining (gastric mucosa).
- Patients taking these drugs should watch for signs of bleeding (e.g Black Tarry stools).
- They should take the medication with food or milk.
- Sometimes we also add medication that will decrease stomach acid production (e.g PPI or histamine-2 blocker).
42
Explain the importance of limiting the use of ketorolac to a maximum of 5 days.
- To reduce the risk of GI bleeding.
- The providers usually also prescribe a medication to protect the stomach (e.g PPI or histamine-2 blocker).
43
Describe the precautions and strategies that can be employed to minimize the risk of GI bleeding in patients taking NSAIDs, such as co-administration of gastroprotective agents.
- They should take the medication with food or milk.
- Sometimes we also add medication that will decrease stomach acid production (e.g PPI or histamine-2 blocker).
44
How can NSAIDs contribute to kidney injury?
- Because NSAIDs inhibit the conversion of arachidonic acid into prostaglandins.
- They do this by inhibiting COX-1, hence decreased kidney blood flow. leading to Nephrotoxicity.
45
Discuss the importance of increasing fiber intake and maintaining adequate hydration in patients taking opioids.
- Opioid receptors causes the bowel motility to slows down hence causing constipation.
- Constipation can cause a lot of discomfort and problems.
- So we often give medicine to help reduce the risk of constipation (e.g., a stool softener or laxative).
- We also encourage fluids and high-fiber foods (e.g., fruits and vegetables).
46
What is the role of naloxone in the management of opioid toxicity, and how does it work as an antidote?
- Naloxone is an opioid antagonist.
- It works by kicking opioids off the receptors and blocking them from reattaching.
47
Describe the signs and symptoms of opioid toxicity, and explain when naloxone should be administered.
- CNS depression such as:-
* Sedation
* Hypotension
* Decreased respiratory rate
* Miosis - pinpoint pupil
- Naloxone should be administered:-
* When we have an Opioid toxicity.
48
What is the main indication for drugs like tizanidine?
- Its a muscle relaxant.
- Common uses for these medications include muscle spasms due to injury/surgery and spasticity due to cerebral palsy, spinal cord injury, or multiple sclerosis.
49
List the common adverse drug reactions associated with donepezil use, including gastrointestinal and cardiovascular.
- Drug interactions (Avoid TCA, Antihistamines, Oxybutynin).
- Bradycardia & Syncope (fainting).
- Cholinergic effects (GI issues is the most common issue)
* Urinary frequency
* Nausea
* Diarrhea
- Realistic Expectations (the meds dont stop or even slow down the disease so we should not give the Pt false hopes).
50
Discuss the limitations of donepezil therapy in altering the overall progression of Alzheimer's disease, and explain why it is considered a symptomatic treatment rather than a disease-modifying therapy.
- It does not stop or even slow disease progression.
- It temporarily improves clients’ memory.
51
What should you assess before administering oral medication to someone who has myasthenia gravis?
- Their Swallowing Ability
(Ask the Pt to take a few sips of water in order to assess the swallowing ability. if they cant swallow notify the provider and request for an IV order).
52
Describe the symptoms of overmedication (cholinergic crisis) in patients with myasthenia gravis, including the key signs and symptoms related to excessive acetylcholine stimulation.
(SLUDGE,BBB) mnemonic
- Salivation
- Lacrimation (excess tearing)
- Urination
- Diaphoresis / Diarrhea
- GI cramps
- Emesis (vomiting)
- Bradycardia
- Bronchospasm
- Bronchorrhea (lots of watery sputum)
53
What are the key clinical parameters and outcomes used to evaluate the effectiveness of levodopa in the treatment of Parkinson's disease?
- Levodopa is combined with Carbidopa to prevent Levodopa from converting to dopamine before it crosses the blood-brain barrier.
- This keeps the dose of levodopa lower and prevents a lot of adverse effects.
54
Explain the purpose of carbidopa when it is co-administered with levodopa in the treatment of Parkinson's disease.
- It helps prevent Levodopa from converting into Dopamine before it crosses the Blood Brain Barrier, Because Dopamine cannot cross the BBB.
- It wont cross the BBB, but helps the Levodopa to cross the BBB
55
What is the generally accepted therapeutic level range for phenytoin when used for seizure control?
- 10 - 20
56
Describe the risk factors for phenytoin-induced gingival hyperplasia and the precautions that can be taken to minimize this side effect.
🔶 The risk factors for phenytoin-induced gingival hyperplasia include:-
* The high serum levels of Phenytoin.
🔶 The precautions that can be taken to minimize this side effect of phenytoin-induced gingival hyperplasia include:-
* Encourage clients to practice good dental hygiene.
* Encourage the use of soft toothbrush.
57
What is the relationship between angiotensin-converting enzyme inhibitors (ACEIs) and the risk of angioedema?
* Angioedema - Is a potentially fatal reaction (swollen face, lips, throat, eyes) that develops in clients with African descent from taking ACE inhibitors the "Pril".
- Give Epinephrin to reduce the reaction.
- You should avoid and never take the ACE inhibitors the "Pril" after developing Angioedema once.
58
What alternative antihypertensive medications can be considered for patients who develop a cough related to ACEI use?
- Angiotensin II Receptor Blockers (ARBs)
(They end with "sartan" or "tan")
* Losartan
* Olmesartan
* Valsartan
- They do not cause a cough.
59
List the main contraindications for the use of beta-blockers (BBs) in clinical practice.
- Hypotension
- Bradycardia
- Blood sugar regulation - (check the blood sugar often) (hypoglycemia)
- Bronchoconstriction (Asthma & COPD avoid)
- Depression (propranolol)
- Erectile dysfunction (in men)
60
What diuretic can cause tinnitus?
- Furosemide
61
Describe the primary indication of mannitol as an osmotic diuretic.
- It treats Cerebral Edema
62
Discuss the risk of hypokalemia with diuretic use, and describe the strategies that can be employed to minimize this risk.
- Signs of Hypokalemia:-
* Weakness, fatigue
* Muscle cramps
* Dysrhythmias
* Nausea, and vomiting
- Risks of hypokalemia are:-
* Muscle cramps
* Ventricular arrhythmias
* Cardiac arrest
- This can be minimized by:-
* Eating food rich in potassium (Bananas, Sweet potatoes, baked Potatoes e.t.c
63
What is the generally accepted therapeutic range for digoxin?
* 0.5 - 2.0
64
What parameters and clinical assessments should be performed before administering digoxin to a patient?
- Draw the blood to check the Trough levels.
- Check the Apical pulse. (if the pulse is less that 60, hold the mediation and notify the provider.)
65
Describe the different types of angina, including stable angina, unstable angina, and variant (Prinzmetal) angina.
🔶 Stable Angina
- Happens when there is a partial blockage of the Coronary Artery.
- When the Pt is resting there is no pain, but when the Pt is doing any physical activity there is pain.
🔶 Unstable angina.
- Happens when one of the plaques in the Coronary artery raptures and causes a clot that partially blocks the vessels.
- It happens at anytime. its considered a Medical Emergency.
🔶 Variant Angina (Prinzmetal’s Angina, Vasospastic Angina)
- The Pt have Coronary Arteries that Spasms.
- It happens while the Pt is Resting or Sleeping.
66
List the common side effects associated with the use of nitrates.
- Orthostatic Hypotension
- Nitrate free intervals
- Incompatibility with Erectile dysfunction drugs
- Headache (increases the pressure in the brain)
- Proper storage (stored in special container that protects the meds from moisture)
- Teaching for Sublingual Nitroglycerin (take at the onset of chest pain, Take a total of 3 tablets 5 mins apart)
67
What type of Angina is considered as a "Medical Emergency"?
Unstable Angina
68
Describe the appropriate timing and administration of sublingual (SL) nitroglycerin for the management of acute angina episodes, including the recommended dosing intervals and when to seek medical attention.
- Teach the Patient to:-
* Take the medication at the onset of chest pain. Don’t wait until the pain becomes severe.
* Sit down, place the tablet under your tongue, and let it dissolve. Don’t swallow it. (The first-pass effect will destroy most of it if you do.)
* If the pain is not relieved after 5 minutes, this might indicate you are having a heart attack. Call 911, and take another tablet while you wait.
* If after another five minutes, the pain persists, you can take one last tablet. This means a client can take a total of 3 tablets.
69
Explain the purpose of anticoagulant therapy (blood thinners) in patients with atrial fibrillation.
- They helps reduce the likelihood of blood clots forming in the heart.
70
Describe the common and potentially serious adverse drug reactions (ADRs) associated with long-term Amiodarone use.
* Amiodraone Toxicities
- Amiodarone is very lipid soluble.
- Has a very long half-life (about 100 days). -
- That means it can build up tissues, causing toxicities.
- Patients taking this medication sometimes develop:-
* Lung problems (pulmonary fibrosis)
* Liver issues (hepatotoxicity)
* Thyroid problems (hypothyroidism or hyperthyroidism)
* Eye problems (optic neuropathy & corneal deposits)
- If a client is beginning long-term Amiodarone therapy, it’s a good idea to perform baseline testing of the lungs, liver, thyroid, and eyes.
71
List the common and potentially serious adverse effects of statins.
- Hepatotoxicity
- Myopathy & Rhabdomyolysis
- Time of Dose
- Food Interactions
- Contraindications
72
Describe the signs and symptoms of myopathy in patients taking statins, and explain the importance of monitoring for this potential adverse effect during statin therapy.
- Signs and symptoms of Myopathy (Rhabdomyolysis) includes:-
* Severe muscle pain and aches.
* Dark urine (Cola-colored urine)
- Sometimes myopathy can progress to a very serious condition called rhabdomyolysis. Rhabdomyolysis occurs when muscle cells start dying. As these cells burst open, high levels of myoglobin and creatine kinase (CK) leak into the bloodstream, causing damage to the kidneys. This can progress to kidney failure.
73
Explain the laboratory monitoring parameters and recommended frequency for patients receiving heparin and warfarin therapy.
- Warfarin - INR (btw 2 and 3)
- Heprarine - PTT (Btw 60 and 80 secs)
- Enoxaparin - anti-Xa (0.6
74
Describe the proper technique for administering subcutaneous heparin and enoxaparin injections, including site selection.
- Enoxaparin administration (Love handles SubQ)
75
Describe the importance of auscultating breath sounds after administering a respiratory treatment, such as a bronchodilator or nebulizer therapy, and explain how this assessment helps evaluate the effectiveness of the treatment.
- We auscultate the breath sounds to make sure that the Nebulizer therapy is effective by making sure the airway is relaxed, allowing enough air into the lungs, hence there will be no wheezing.
🔶 SABAs
- Albuterol and Levalbuterol
- they start working in 5 mins and lasts a few hours)
- its rescue medications
🔶 LABAs
- They have a slow onset of actions but last for 12 hours.
76
Describe the potential effects of albuterol on heart rate, and explain the underlying mechanism responsible for this effect.
- It increased sympathetic stimulation causing :-
* Tachycardia
* Palpitation
* Muscle tremors
* Restlessness
77
Explain the importance of rinsing the mouth after using inhaled glucocorticoids.
- To prevent Candidiasis or thrush in the mouth.
78
How do first-generation antihistamines differ from second-generation antihistamines?
🔶 First Generations (Old Antihistamines)
* Can easily cross the Blood Brain Barrier
* Prescribed for Extrapyramidal effects (Benadryl)
* Prescribed for :-
1) Allergic reactions
2) Nausea
3) Cough
4) Insomnia
5) Itching (Pruritis)
🔶 Second Generations (Newer Antihistamines)
* It has a long half-life
* Do not cross the Blood Brain Barrier
* Good choice for Allergic Rhinitis
79
How do nasal decongestants like pseudoephedrine work?
- The Alpha1 receptors are found in the smooth muscles that surround blood vessels.
- When alpha1 receptors are activated, vasoconstriction occurs.
- Phenylephrine and pseudoephedrine activate alpha1 receptors, resulting in vasoconstriction in the nasal mucosa.
- This decreases nasal congestion.
80
Identify the most serious adverse effect associated with the use of insulin therapy and explain the potential consequences if left untreated.
* Hypoglycemia
- Insulin is a high-risk medication.
- Low blood sugar can cause death.
- Typically you need to check a client’s blood glucose level before giving insulin.
- A blood glucose level should be greater than 70 mg/dL.
- Make sure you know and can teach clients the signs and symptoms of hypoglycemia
81
Describe the signs and symptoms of hypoglycemia and discuss the importance of prompt recognition and management in patients receiving insulin therapy.
🔶 Signs of Hypoglycemia include:-
* Sweating
* Rapid heart rate
* Nervousness
* Irritability/confusion
* Shaking
* Hunger
* Fatigue
🔶 The PT should avoid skipping meals
82
Compare the onset of action and duration of commonly used insulins.
* Rapid-acting insulin - an onset of 15-30 mins)
83
Describe the key clinical parameters and laboratory tests used to evaluate the effectiveness of levothyroxine therapy in patients with hypothyroidism.
- The normal range for TSH is about 0.5 to 5 mU/L.
84
List the common adverse reactions associated with levothyroxine therapy.
* Insomnia
- Take in the morning on an empty stomach.
* Drug interactions
- Avoid taking them with Calcium, Iron supplements, Vitamins and Antacids.
* Drug toxicity
- Monitor for signs of Hyperthyroidism.
* Lifelong therapy
- People with hypothyroidism will typically take levothyroxine for the rest of their life. Teach clients not to discontinue the medication even after they feel better.
* Dose adjustment
- This drug has a narrow therapeutic index, there are many reasons a client’s dose might need to be adjusted (e.g., weight changes, other diseases, drug interactions).
-The dosing of levothyroxine is counterintuitive. The normal range for TSH is about 0.5 to 5 mU/L.
* Changing brands
- Clients considering changing brands should first consult their healthcare provider.
85
Identify the primary causes of peptic ulcer disease (PUD).
- H.pylori (Helicobacter pylori)
86
List the main indications for the use of proton pump inhibitors (PPIs) and histamine-2 receptor blockers (H2 blockers).
- To reduce the stomach acid secretion.
- To promote healing.
- Prevent further damage.
87
Describe the main indications for the use of docusate.
- Its prescribed to Hospitalized patients to prevent constipation, especially if they are taking an opioid.
88
Discuss the potential dangers and risks associated with the overuse of stimulant laxatives.
- Decrease bowel tone.
- Lead to dependence.
- It causes bowel perforation and sever cramps
- it irritates the GI tract (nausea, cramping, and bloating).
89
Explain the therapeutic effect of allopurinol in the management of gout.
* Allopurinol - is a xanthine oxidase (XO) inhibitor. When you block this enzyme, you don’t get much nearly as much xanthine or uric acid in the bloodstream.
- Hypoxanthine is very water-soluble. That means it doesn’t crystalize and the kidneys have no trouble excreting it.
90
Describe the gastrointestinal (GI) side effects associated with the use of colchicine.
- Nausea
- Vomiting
- Diarrhea
91
Describe the key points to include in patient teaching regarding the use of bisphosphonates.
- Hypocalcemia - (Cause a decrease in Calcium levels)
- Esophagitis - (Don't lay down after taking the medications, you should move around)
- Food interactions - (Take on a complete empty stomach, wait 30 mins before eating a meal, taken in the morning 30 mins before breakfast).
92
Discuss the role of vitamin D in bone health.
- Its prescribed for diseases associated with vitamin D deficiency.
- In children vitamin D deficiency is called rickets.
- In adults, it is called osteomalacia.
- Vitamin D is also prescribed to clients taking bisphosphonates for osteoporosis and for hypoparathyroidism.
- Sometimes vitamin D is taken to prevent other conditions (diabetes, arthritis, cardiovascular disease, autoimmune disorders, and cancer), however, the evidence for these uses is lacking.
93
List common disease-modifying antirheumatic drugs (DMARDs) used in the management of rheumatoid arthritis (RA).
* Methotrexate
* Hydroxychloroquine
* Adalimumab
* Cyclosporine
94
Discuss the common adverse effects associated with long-term corticosteroid use.
* Osteoporosis
* Gastric Ulceration
* Weight gain
* Elevated Blood Glucose
* Hypokalemia
* Adrenal Insufficiency
95
Explain the mechanism of action of 5-alpha reductase inhibitors (5-ARIs) in the management of benign prostatic hyperplasia (BPH).
- 5-alpha-reductase inhibitors block the enzyme that converts testosterone into dihydrotestosterone (DHT)—the active form of testosterone.
- Since DHT is what triggers the prostate to grow, this halts the growth of the prostate and even shrinks it.
- Since DHT also plays a role in male-pattern baldness, these drugs also help regrow hair.
96
Describe the key clinical parameters and patient-reported outcomes used to evaluate the effectiveness of 5-ARIs in the management of BPH
- PSA levels checked before starting the medications.
- PSA levels checked again after 6 months.
- If the PSA levels do not drop as expected, evaluate for cancer.
97
Discuss the potential effects of alpha-1 blockers, a class of medications used in the management of BPH and hypertension, on blood pressure.
- It block receptors in the peripheral vasculature, decreasing blood pressure.
- Can cause postural hypotension.
98
Explain the importance of obtaining appropriate cultures before initiating antibiotic therapy.
- This helps the Provider know which Antibiotic will be most effective.
- To improves the chances of identifying the offending microorganism, which improves patient care.
99
What is the priority intervention if a patient experiences a reaction during IV antibiotic infusion, and why is it important to act quickly?
- Stop the infusion.
- We act quickly because it can be fatal and the patient can die.
100
Describe the potential signs and symptoms of an allergic or anaphylactic reaction.
🔶 The Allergic reactions are:-
* Hives
* Rash
* Itching
* Swelling
🔶 The Anaphylaxis signs are :-
* Nausea
* Vomiting
* Difficulty breathing
* Low blood pressure
* Loss of consciousness.
101
Describe the proper administration and monitoring of vancomycin.
🔶 When infusing you should:-
* Infuse slowly (1-2 hours depending on the dose)
* If infused rapidly it can cause Red man syndrome
🔶 When monitoring you should:-
* Becoz its Nephrotoxic check creatinine, BUN
* Check trough level (before, during and 30 min after administration the antibiotic)
102
List the common adverse drug reactions (ADRs) associated with cytotoxic medications, including appropriate nursing interventions for managing them.
- Bone Marrow Suppression (Myelosuppression)
- Damage to the GI Tract
- Nausea and Vomiting
- Hair Loss (Alopecia)
- Local Tissue Injury (Extravasation)
- Cancer
103
Describe the common ADRs associated with cisplatin.
- Nephrotoxicity
- Ototoxicity (Hearing loss & Dizziness)
- Bone Marrow Suppression
- Damage to the GI Tract
- Nausea and Vomiting
- Hair Loss (Alopecia)
- Local Tissue Injury (Extravasation)
- Cancer
104
Explain the potential ADRs associated with doxorubicin
- Cardiotoxicity
- Red sweat, urine and tears.
105
Describe the proper administration technique for eye drops.
- Keep the tip sterile.
- Administer the meds in the pocket of the lower eyelids (Conjunctival sac).
- If the client needs another dose, they should wait for 5 mins before giving another eye drop.
- Remove any contact lenses before administering the eye drops and wait for 10-15 mins before putting them back on.
106
Discuss the potential effects of latanoprost on the iris and eyelashes
- Darkened iris.
- Growth of long.
- Thick eyelashes.
107
Explain why intravenous (IV) potassium must be administered via a pump.
- Because its very irritating to the vein.
- Choose a larger vein
- Infuse in the pump slowly
108
Describe the potential increased risk of thrombosis associated with the use of oral contraceptives, particularly among women with other risk factors such as smoking, obesity, or a personal or family history of blood clots.
- If a person has breast cancer, they will accelerate tumor growth.
- There is an increased risk of thrombotic events, especially if the person smokes.
109
Discuss the indications for ondansetron.
- Its an Anti-nausea medication.
- It works by blocking serotonin (5-HT3) receptors in areas of the brain that trigger nausea and vomiting.
110
Explain the contraindications for the use of sildenafil.
- Clients should also avoid taking nitrates (angina medications)
- This cause a dangerous drop in blood pressure.
111
Describe the common adverse drug reactions (ADRs) associated with iron supplements.
- Its irritating to the stomach and often causes nausea.
- Don't take it with food, it will decrease absorption.
- Best taken with orange juice.
- Causes constipation and black tarry stool.
112
Explain why it is important to assess for the use of herbal medications in patients.
🔶 Herbals and supplements sometimes have the same effects as medications. That could cause the drug’s effect to be too strong.
🔶 Herbals and supplements sometimes have opposing effects on medications. That could cause the two substances to cancel each other out.
🔶 Sometimes herbals and supplements are metabolized by the same enzymes as other medications. This could cause the drug levels to become too high or low.
113
Describe the key differences between herbal medications and FDA-approved medications.
- They have to convince the FDA the drug is safe and effective.
- Herbal and supplemental companies don’t have to just through all of these hoops.
- That’s not to say they don’t work but don’t believe everything you hear about them.
114
What is the Antidote of :-
1) Opioid Toxicity
2) Digoxin toxicity
3) Heparin
4) Warfarin
5) Acetaminophen
6) Methotrexate
7) Aspirin
8) Insulin
9) Cholinergic crisis
10) Doxorubicine
1) Opioid - Naloxone
2) Digoxin - Digoxin immune Fab
3) Heparin - Protamine sulfate
4) Warfarin - Vitamin K
5) Acetaminophen - Acetylcysteine
6) Methotrexate - Leucovorin
7) Aspirin - Activating charcoal
8) Insulin - Glucagon
9) Cholinergic crisis - Atropine
10) Doxorubicine - Dexrazoxane
