Pharm NCLEX review Flashcards
What drug class is good for symptoms of alcohol withdrawal? In particular, what drug from within that class is best? Why?
Benzodiazapines
Chlordiazapoxide
It has a longer half-life than other benzos
Why would the rheumatoid arthritis med infliximab be contraindicated in a person with Hep B?
It is a tumor necrosis factor antibody med and causes immunosuppression. If a person has an infection such as Hep B then infliximab could suppress the body’s immune reation.
What is the indicataion for amantadine? What is a drug used to treat schizophrenia that can have Parkinsonian adverse effects?
Parkinsonian symptoms and extrapyramidal manifestions?
chlorpromazine
What is the MOA of dobutamine hydrochloride? And what would be its therapeutic effect on a client with heart failure?
vasopressor
it improves cardiac output which improves the hemodynamic status
What is the MOA of lactulose? How could it be helpful in treating someone with cirrhosis?
a laxative that decreases ammonia levels by increasing intestinal ammonia secretions
helps make up for the lack of effectiveness of the liver’s ability to process ammonia
What is cycloplegia? What med can cause this effect? Why? What would the client report if they were experiencing this AE?
inability to accommodate from far to near vision
atropine
paralyzes the ciliary muscles
blurred vision
Why is the PUD med misoprostol categorized as a pregnancy X?
It can stimulate uterine contractions and cause a spontaneous abortion
Why are opioid pain relievers and benzo incompatible and should not be taken together?
both cause respiratory depression
What can cause digoxin-induced dysrhythmias? What is commonly prescribed if client is taking a diuretic concurrently with digoxin? What is generally the fiest manifestations of digoxin toxicity? CNS toxicity effects of dig?
hypokalemia
increased digoxin blood levels
heart disease
potassium
or potassium-sparing diuretic like spironolactone
anorexia
N/V
abdominal pain
fatigue and weakness
vision changes such as blurred vision and/or halos
What drug class is filgrastim? MOA? When would this be helpful?
leukopoietic growth factors
stimulates bone marrow to increase production of neutrophils
in decreasing the chance of infection in cancer and other conditions where neutropenia occurs
and to help build of neutrophils for autologous stem cell transplant
What meds are alpha-adrenergic antagonists that can treat BPH and urinary hesitancy? MOA? What symptoms will the client likely experience taking this drug?
the -osins like tamsulosin, alfuzosin, terazosin, doxazosin
vasodilation which can lower HTN and increase urinary flow
hypotension, dizziness, nasal congestion, faintness, sleepiness, problems with ejaculation
What is NMS? Manifestations? Nursing actions?
neuroleptic malignant syndrome, life-threatening adverse effect. Can occur with antipsychotics.
sudden high-grade fever
change in BP
dysrhythmia, tachycardia
muscle rigidity
diaphoresis
change on LOC, coma
stop med
monitor VS
apply cooling blankets
antipyretics
increase fluids
benzos fr anxiety
dantrolene to relax muscles
ICU
wait 2 weeks to resume therapy
What are anticholinergic effects? (think slowing down)
dry mouth
blurred vision
tachycardia
urinary retention
photophobia (dilated pupils)
conspipation
What is the prototype biphosphonate?MOA? Therapeutic effect? Side effects? What can decrease its absorption and should not be taken together? How much time should be allowed between taking these meds/foods? What should it be supplemented with?
alendronate
decreases the number and action of osteoclasts, inhibiting bone resorption
osteoporosis
esophagitis, ulcerations
abd. pain, N/V, constipation
bone pain
blurred vision, eye pain
calcium
iron
mag
antacids
OJ
caffeine
2 hours
calcium/vit D
weight bearing exercise
What meds can interact with St John’s Wort? What can result? What meds can St. John’s Wort affect effectiveness with concurrent use?
antidepressants, amphetamines, cocaine
serotonin syndrome
oral contraceptions
cyclosporine
warfarin
digoxin
CCBs
steroids
HIV protease inhibitors/anticancer
What is the non-insulin injectable antidiabetic prototype? Therapeutic use? What is the greatest risk when used concurrently with insulin or other antidiabetic meds? Administration instructions?
pramlintide and other -tides
supplemental glucose control for T1 and T2 by decrease gastric emptying of glucagon
hypoglycemia
administer prior to meals
wait 1-2 hours to administer other oral meds to prevent disruption of their absorption
refrigerate the unsed portion for up to 28 days
What is agranulocytosis? What med can help reverse it? S/S?
dangerously low levels of neutrophils
filgrastim
sore throat, fever, infection symptoms
What do the -sartan meds do? Therapeutic use?
they are angiotensin receptor blockers that block the action of angiotensin II in the body causing vasodilation and excretion of sodium and water d/t decreased aldosterone
HTN, heart failure
stroke nd MI aprevention
delays the progression of diabetic neuropathy and retinopathy
What med reduces prostate size and increases hair growth? Complication?
finasteride
decreased libido and ejaculate volume
What can be given as a pretreatment for the complications of the antifungal amphotericin B?
diphenhydramine and acetominophen
What are important client instructions to avoid lithium toxicity? S/S of toxicity?
adequate fluid and sodium intake
emphasize high risk for toxicity so keep the level check appts.
monitor for s/s and contact provider
D/V
excessive sweating
tremors
increased thirst/urination
rash
What is the risk of the -ozoles that treat GERD? S/S?
hypomagnesemia
muscle cramps
tachycardia
hyperactive DTR
insomnia
When is the administration of atropine appropriate during CPR? When is the administration of epinephrine appropriate during CPR?
symptomatic bradycardia
hemodynamically unstable
asystole
pulseless electrical activity
What is the MOA of epinephrine and dopamine? Therapeutic use?
Alpha and Beta 1 receptors
HF, shock
hypertensive crisis leading to cerebral hemorrhage
dysrhythmias, increases workload of the heart
What are S/S of NMS? Order of nursing actions?
sudden high-grade fever
autonomic instability such as BP fluctuations and dysrhythmias
muscle rigidity
diaphoresis
tachycardia
stop antipsychotic
monitor VS
apply cooling blankets
administer antipyretic
increase fluid intake
diazepam for anxiety
dantrolene to relax muscles
transfer to ICU
wait 2 weeks before resuming therapy
With MAOIs, what foods are restricted? Examples?
tyramine containing foods
cheese and cured meats
What is the concerning side effect of the “pril” ace inhibitors and should be reported? What causes it? Other side effects?
cough
inhibition of kinase can result in increase of bradykinin
1st dose orthostatic hypotension
hyperkalemia
rash, dysgeusia (altered taste)
angioedema (swelling of tongue and oral pharynx
neutropenia
What is the MOA of propranolol? Adverse effects? Contraindicated in who?
beta blocker
hypotension
bradycardia
HF
AV block
sinus arrest
fatique
bronchospasm
asthma (because of bronchospasms)
What is the therapeutic use of clonidine? Complications? Client education? Similar meds?
HTN
sever cancer pain
drowsiness
dry mouth
rebound HTN if abruptly stopped
be compliant
dry mouth resolves in 2-4 weeks
chew gum, ice chips
methyldopa
guanfacine
What is aPTT? Normal value range? What med requires monitoring of aPTT?
partial thromboplastin time
1.5-2X the baseline
Heparin
What is the is the preferred site for up to 1 mL of I injection? 2mL
deltoid
ventrogluteal
What is nursing care with TPN?
adjusting flow rate/abruptly stopping is contraindicated (can alter glucose levels)
assess VS q4-8hr
change tubing and solution q24h
ensure tubing filter
dedicated line
sterile technique when changing central line dressing
check glucose q4-6h
keep dextrose 10% at bedside
What manifestations would you see with a right-hemisphere distrubance? Left-sided?
altered perception deficits (overestimate abilities)
left-sided neglect
loss of depth perception
poor impulse control and judgement
visual changes
aphasia
agnosia (unable to recognize familiar objects
alexia (reading difficulty)
agraphia (writing)
right-sided hemiplegia
slow, cautious behavior
depression, anger, quick to become frustrated
visual changes
What are the precautions with meningitis? Is meningitis reported to the health department? Complications of menigitis? Nursing actions to prevent these complications?
droplet until antibiotics have been administered for 24 hours
with bacterial may remain on droplet otherwise standard after 24 hrs
yes
ICP
SIADH
septic emboli leading to DIC or stroke
HOB 30 degrees
no sneezing or coughing
monitor for indications (LOC, extraocular movements or pupillary changes)
Possible mannitol
monitor daily weights and I&O
Monitor circulatory status, cap refill regualarly
report alterations immediately
What are MS manifestations?
fatigue
pain or parethesia
vision changes
tinnitis
vertigo
dysphagia
dysarthria (slurred or nasaly speech)
muscle spasms
ataxia or muscle weakness
bowel/bladder dysfunction
cognitive changes such as memory loss or impaired judgement
sexual dysfunction
What are the manifestations of lithium toxicity?
N/V/D, polyuria, muscle weakness leading to seizures and death
Which cranial nerves affect extraocular movements?
oculomotor
trochlear
abducens
What can bupropion adversely lower? Who should be prescribed this with caution?
seizure threshold
past head injuries
seizure disorder
