PHARMA MIDTERM Flashcards
: a group of drugs used to treat fungal infections
azoles:
fungus that is normally found on mucous membranes; can cause
yeast infections or thrush of the gastrointestinal (GI) tract and vagina in
immunosuppressed patients
Candida:
steroid-type protein found in the cell membrane of fungi;
similar in configuration to adrenal hormones and testosterone
ergosterol:
a cellular organism with a hard cell wall that contains chitin and
many polysaccharides, as well as a cell membrane that contains
ergosterols
fungus:
disease caused by a fungus
mycosis:
: fungus called ringworm that causes such infections as athlete’s
foot, jock itch, and others
tinea
for reducing the incidence of candidiasis in bone mar- row transplant recipients
prophylaxis
Treatment of candidiasis, cryptococcal meningitis, other systemic fungal infections
fluconazole (Diflucan)
Treatment of invasive aspergillosis, invasive mucormycosis
isavuconazonium (Cresemba)
Treatment of blastomycosis, histoplasmosis, and aspergillosis
itraconazole (Sporanox)
Treatment of aspergillosis, leishmaniasis, cryptococ- cosis, blastomycosis, moniliasis, coccidioidomy- cosis, histoplasmosis, and mucormycosis
ketoconazole (generic)
Prophylaxis of invasive Aspergillus and Candida infections in adults and children >13 y who are immunosuppressed secondary to antineoplastic,
posaconazole (Noxafil)
Treatment of onychomycosis of the fingernail or toenail caused by dermatophytes;
terbinafine (Lamisil
Treatment of invasive aspergillosis; treatment of serious fungal infections caused by Scedosporium apiospermum or Fusarium spp.
voriconazole (Vfend)
Treatment of candidemia (infection of the blood- stream) and other forms of Candida infection, intra- abdominal infections, and esophageal candidiasis
anidulafungin (Eraxis)
Ketoconazole, fluconazole, and itraconazole work by
blocking the activity of
a sterol in the fungal wall
are triazole antifungals that inhibit the synthesis of
ergostero
Posaconazole, voriconazole, and
isavuconazonium
a similar drug that blocks the
formation of ergosterol
Terbinafine
Ketoconazole is absorbed rapidly from the GI tract, with peak levels
occurring within
1 to 3 hours
Fluconazole reaches peak levels within
1 to 2
hours after administration
Ketoconazole and fluconazole strongly inhibit the CYP450 enzyme system in
the
liver
are a large group of antifungals used to treat systemic and topical
fungal infections
azoles
Posaconazole is given orally, has a rapid onset of action, and peaks within
3
to 5 hours
ketoconazole is not the drug of choice for patients with
endocrine or fertility problems
itraconazole has been associated with
hepatic failure
have been associated with severe liver toxicity and are
contraindicated with liver failure
Terbinafine
and isavuconazonium
work by inhibiting glucan synthesis.
echinocandins
is an enzyme
that is present in the fungal cell wall but not in human cell walls.
Glucan
is a less toxic drug that alters the cell membrane of
susceptible fungi, causing cell death
Flucytosine
is an older antifungal that acts in much the same way,
changing cell membrane permeability and causing cell death.
Griseofulvin
binds to sterols in the cell wall, changing membrane
permeability and allowing leaking of the cellular components
Nystatin
is well absorbed from
the GI tract, with peak levels occurring in 2 hours
Flucytosine
. Fungi that cause these
mycoses are called
dermatophytes.
are often referred to as ringworm, although the causal
organism is a fungus, not a worm
tinea
infections,
athlete’s foot
(tinea pedis)
jock itch
(tinea cruris)
yeast
infections of the mouth and vagina often caused by
Candida.
Available OTC for treatment of vaginal Candida infections
butoconazole
(Gynazole)
Available OTC for treatment of oral and vaginal Candida infections; tinea infections
clotrimazole (Lotrimin, Mycelex)
Treatment of tinea
econazole (Spectazole)
Treatment of onychomycosis of the toenails due to Trichophyton rubrum, Trichophyton mentagrophytes
efinaconazole (Jublia)
Treatment of seborrheic dermatitis, tinea corporis, tinea cruris, tinea pedis
ketoconazole (Extina,
Xolegel)
Treatment of interdigital tinea pedis, tinea cruris, tinea corporis
luliconazole (Luzu)
Treatment of local, topical mycoses, including blad- der and vaginal infections and athlete’s foot
miconazole (Monistat-3)
Short-term (up to 4 wk) treatment of topical mycosis
oxiconazole (Oxistat)
Treatment of tinea pedis infections (up to 4 wk)
sertaconazole nitrate (Ertaczo)
Treatment of tinea infections
sulconazole (Exelderm)
Short-term (1-4 wk) treatment of topical mycosis: treatment of tinea infections
terbinafine (Lamisil)
Local treatment of Candida infections
terconazole (Terazol)
Treatment of recurrent vaginal Candida infections
tioconazole (Vagistat-1)
Treatment of tinea infections
butenafine (Mentax)
Treatment of topical tinea infections; solution for treatment of toenail and fingernail tinea infections caused by Trichophyton rubrum
ciclopirox (Loprox, Penlac Nail Lacquer)
Treatment of topical mycosis
gentian violet (generic)
Short-term treatment of severe topical mycosis (up to 4 wk)
naftifine (Naftin)
Treatment of onychomycosis of the toenails
tavaborole (Kerydin)
Available OTC for treatment of athlete’s foot
tolnaftate (generic)
Available OTC for treatment of athlete’s foot, jock itch, diaper rash, burning, and chafing in the groin area
undecylenic acid (Cruex, Desenex)
work to alter the cell permeability of the fungus,
causing prevention of replication and fungal death
topical antifungal drugs
A patient with a fungal infection asks the nurse why she cannot take
antibiotics. The nurse explains that the reason for this is that a fungus is resistant to antibiotics because
a. a fungal cell wall has fewer but more selective protective layers.
b. the composition of the fungal cell wall is highly rigid and
protective.
c. a fungus does not reproduce by the usual methods of cell
division.
d. antibiotics are developed to affect only bacterial cell walls.
d. antibiotics are developed to affect only bacterial cell walls.
When administering a systemic antifungal agent, the nurse
incorporates understanding that all systemic antifungal drugs
function to
a. break apart the fungus nucleus.
b. interfere with fungus DNA production.
c. alter cell permeability of the fungus, leading to cell death.
d. prevent the fungus from absorbing needed nutrients.
c. alter cell permeability of the fungus, leading to cell death.
After assessing a patient, the nurse would question an order for
amphotericin B to prevent the possibility of serious nephrotoxicity if
the patient was also receiving which of the following?
a. Digoxin
b. Oral anticoagulants
c. Phenytoin
d. Corticosteroids
a. Digoxin
The nurse is describing fungi that cause infections of the skin and mucous membranes, appropriately calling these which of the
following?
a. Mycoses
b. Meningeal fungi
c. Dermatophytes
d. Worms
c. Dermatophytes
After teaching a group of students about topical fungal infections,
the instructor determines that the students need additional instruction
when they identify which of the following as an example?
a. Athlete’s foot
b. Rocky Mountain spotted fever
c. Jock itch
d. Vaginal yeast infections
b. Rocky Mountain spotted fever
Which of the following would the nurse recommend that a woman
with repeated vaginal yeast infections keep on hand?
a. Tolnaftate
b. Butenafine
c. Clotrimazole
d. Naftifine
c. Clotrimazole
The nurse instructs the patient to use care when applying topical
antifungal agents to prevent systemic absorption because
a. the fungus is only on the surface.
b. these drugs are too toxic to be given systemically.
c. absorption would prevent drug effectiveness.
d. these drugs can cause serious local burning and pain.
b. these drugs are too toxic to be given systemically.
A patient with a severe case of athlete’s foot is seen with lesions
between the toes, which are oozing blood and serum. After teaching
the patient, the nurse determines that the instruction was effective if
the patient states which of the following?
a. “I have to wear black socks and must be careful not to change
them very often because it could pull more skin off of my feet.”
b. “I need to apply a thick layer of the antifungal cream between
my toes, making sure that all of the lesions are full of cream.”
c. “I should wear white socks and keep my feet clean and dry. I
shouldn’t use the antifungal cream in areas where I have open
lesions.”
d. “After I apply the cream to my feet, I should cover my feet in
plastic wrap for several hours to make sure the drug is
absorbed.”
c. “I should wear white socks and keep my feet clean and dry. I
shouldn’t use the antifungal cream in areas where I have open
lesions.”
which is caused by intestinal invasion of
the trophozoite stage of the protozoan Entamoeba histolytica
amebic dysentery
type of mosquito that is essential to the life cycle of
Plasmodium; injects the protozoa into humans for further maturation
Anopheles mosquito
syndrome of quinine toxicity characterized by nausea,
vomiting, tinnitus, and vertigo
cinchonism:
protozoal intestinal infection that causes severe diarrhea and
epigastric distress; may lead to serious malnutrition
giardiasis:
skin, mucous membrane, or visceral infection caused by a
protozoan passed to humans by the bites of sand flies
leishmaniasis:
protozoal infection with Plasmodium, characterized by cyclic
fever and chills as the parasite is released from ruptured red blood
cells;
malaria:
causes serious liver, central nervous system (CNS), heart, and
lung damage
malaria:
a protozoan that causes malaria in humans; its life cycle
includes the Anopheles mosquito, which injects protozoa into humans
Plasmodium
opportunistic infection that occurs
when the immune system is depressed;
Pneumocystis jiroveci pneumonia
frequent cause of pneumonia
in patients with AIDS and in those who are receiving
immunosuppressive therapy
Pneumocystis jiroveci pneumonia
single-celled organisms that pass through several stages in their
life cycle, including at least one phase as a human parasite;
protozoa
found in
areas of poor sanitation and hygiene and crowded living conditions
protozoa
infestation with a protozoan that causes vaginitis in
women but no signs or symptoms in men
trichomoniasis:
a developing stage of a parasite, which uses the host for
essential nutrients needed for growth
trophozoite:
African sleeping sickness, which is caused by a
protozoan that inflames the CNS and is spread to humans by the bite of
the tsetse fly
trypanosomiasis
causes a serious
cardiomyopathy after the bite of the housefly
Chagas disease
is considered to be the most dangerous type of
protozoan
Plasmodium falciparum
causes a milder form of the disease, which seldom
results in death.
Plasmodium vivax
is endemic in many tropical countries and causes
very mild signs and symptoms in the local population
Plasmodium malariae
which is rarely seen, seems to be in the process of
being eradicated
Plasmodium ovale,
are usually given in combination form to
attack the Plasmodium at various stages of its life cycle.
Antimalarial drugs
was the first drug found to be
effective in the treatment of malaria;
Quinine (Qualaquin)
Prevention and treatment of Plasmodium malaria; treatment of extraintestinal amebiasis
chloroquine (Aralen)
Prevention and treatment of Plasmodium malaria in combination with other drugs
mefloquine (Lariam)
Prevention of relapses of Plasmodium vivax and Plasmodium malariae infec- tions; radical cure of P. vivax malaria
primaquine (generic)
Prevention of Plasmodium malaria, in combination with other agents to suppress transmission; treatment of toxoplasmosis
pyrimethamine (Daraprim)
Treatment of uncomplicated malaria caused by Plasmodium falciparum
quinine (Qualaquin)
increases the acidity of plasmodial food vacuoles, causing cell
rupture and death.
Mefloquine
another very old drug for treating malaria, similar to quinine,
disrupts the mitochondria of the Plasmodium.
Primaquine
is used in combination with agents that act more rapidly
to suppress malaria;
Pyrimethamine
an intestinal infection caused by Entamoeba histolytica, is often
known as amebic dysentery
Amebiasis
Prevention and treatment of
Pneumocystis jiroveci pneumonia; used in combination with proguanil for treat- ment of chloroquine-resistant malaria
atovaquone (Mepron)
Treatment of pediatric patients with Chagas disease caused by Trypanosoma cruzi
benznidazole (generic)
Treatment of amebiasis, trichomoniasis, giardiasis
metronidazole (Flagyl, MetroGel, Noritate)
Treatment of diarrhea associated with Cryptosporidium parvum or Giardia lamblia
nitazoxanide (Alinia)
As inhalation treatment of Pneumocystis jiroveci pneumonia; as a systemic agent in the treatment of trypanosomiasis and leishmaniasis
pentamidine (Pentam, NebuPent)
Treatment of trichomoniasis, giardiasis, amebiasis
tinidazole (Tindamax)
After a group of students is taught about protozoal infections, which
infection, if stated by the group as caused by an insect bite, would
indicate the need for additional teaching?
a. Malaria
b. Trypanosomiasis
c. Leishmaniasis
d. Giardiasis
d. Giardiasis
When describing the development of malaria caused by the
Plasmodium protozoan the instructor would explain that the organism depends on
a. a snail to act as intermediary in the life cycle of the protozoan.
b. a mosquito and a red blood cell for maturation.
c. a human liver cell for cell division and reproduction.
d. stagnant water for maturation.
b. a mosquito and a red blood cell for maturation.
A patient who is receiving a combination drug to treat malaria asks
the nurse why. The nurse responds to the patient based on the
understanding that combination drugs are
a. associated with a much lower degree of toxicity when used in
combination.
b. absorbed more completely when administered and taken
together.
c. more effective in preventing mosquitoes from biting the
individual.
d. effective at various stages in the life cycle of the protozoan.
d. effective at various stages in the life cycle of the protozoan.
A patient traveling to an area of the world where malaria is known to
be endemic should be taught to
a. avoid drinking the water.
b. begin prophylactic antimalarial therapy before traveling and
continue it through the visit and for 4 weeks after the visit.
c. take a supply of antimalarial drugs in case he or she gets a
mosquito bite.
d. begin prophylactic antimalarial therapy 2 weeks before traveling
and stop the drugs on arriving at the destination.
b. begin prophylactic antimalarial therapy before traveling and
continue it through the visit and for 4 weeks after the visit.
Amebiasis or amebic dysentery
a. is seen only in Third World countries.
b. is caused by a protozoan that enters the body through an insect
bite.
c. is caused by a protozoan that can enter the body in the cyst stage
in water or food.
d. usually has no signs and symptoms.
c. is caused by a protozoan that can enter the body in the cyst stage
in water or food.
Giardiasis is the most common intestinal parasite seen in the United
States, and it
a. does not respond to drug therapy.
b. can invade the liver and cause death.
c. is seen only in areas with no sanitation.
d. is associated with rotten egg–smelling stool, diarrhea, and
mucus-filled stool.
d. is associated with rotten egg–smelling stool, diarrhea, and
mucus-filled stool.
Pneumocystis jiroveci pneumonia is
a. an endemic fungus found in the human respiratory system.
b. responsive to inhaled pentamidine.
c. an opportunistic bacterial infection.
d. frequently associated with children in day care settings.
b. responsive to inhaled pentamidine.
Trypanosomiasis may assume which of the following two different
forms?
a. African sleeping sickness and Chagas disease
b. Elephantiasis and malaria
c. Dysentery and African sleeping sickness
d. Malaria and Chagas disease
a. African sleeping sickness and Chagas disease
A nurse would note that a patient had a good understanding of his
antimalarial drug regimen if the patient reported,
a. “I keep these pills with me at all times while I’m away and take
them only when I have been bitten by a mosquito.”
b. “I will need to start these pills now and then continue to take
them every day for the rest of my life.”
c. “I’ll start the pills before my trip, keep taking them during the
trip, and for a period of time after I’m home.”
d. “I start taking these pills as soon as I arrive at my vacation
destination, but before I get off the plane.”
c. “I’ll start the pills before my trip, keep taking them during the
trip, and for a period of time after I’m home.”
the most prevalent helminthic infection; fertilized roundworm
eggs are ingested, which hatch in the small intestine and then make
their way to the lungs, where they may cause cough, fever, and other
signs of a pulmonary infiltrate
Ascaris
tapeworm with a head and segmented body parts that is capable
of growing to several yards in the human intestine
cestode
infection of the blood and tissues of healthy individuals by
worm embryos or filariae
filariasis:
worm that can cause disease by invading the human body
helminth:
worms that attach themselves to the small intestine of
infected individuals, where they suck blood from the walls of the
intestine, damaging the intestinal wall and leading to severe anemia
with lethargy, weakness, and fatigue
hookworms:
can cause intestinal obstruction as the
adult worms clog the intestinal lumen or severe pneumonia when the
larvae migrate to the lungs and form a pulmonary infiltrate
nematode:
roundworms such as the commonly encountered pinworm,
whipworm, threadworm, Ascaris, or hookworm that cause a common
helminthic infection in humans;
nematode:
nematode that causes a common helminthic infection in
humans; lives in the intestine and causes anal and possible vaginal
irritation and itching
pinworm:
flatworms, including the cestodes or tapeworms; a worm
that can live in the human intestine or can invade other human tissues
(flukes)
platyhelminth
infection with a blood fluke that is carried by a snail; it
poses a common problem in tropical countries, where the snail is the
intermediary in the life cycle of the worm
schistosomiasis
where the snail is the
intermediary in the life cycle of the worm; larvae burrow into the skin
in fresh water and migrate throughout the human body, causing a rash,
diarrhea, and liver and brain inflammation
schistosomiasis
pervasive nematode that can send larvae into the lungs,
liver, and central nervous system (CNS); can cause severe pneumonia
or liver abscess
threadworm:
disease that results from ingestion of encysted roundworm
larvae in undercooked pork
trichinosis
; larvae migrate throughout the body to
invade muscles, nerves, and other tissues; can cause pneumonia, heart
failure, and encephalitis
trichinosis
worm that attaches itself to the intestinal mucosa and sucks
blood; may cause severe anemia and disintegration of the intestinal
mucosa
whipworm
are usually transmitted when the worm eggs are ingested, either
by transfer by touching the eggs when they are shed to clothing, toys, or
bedding; or by the inhalation of eggs that become airborne and are then
swallowed.
Pinworms
are transmitted when eggs found in the soil are ingested.
Whipworms
can cause more damage to humans than most of the other
helminths. ________ are transmitted as larvae found in the soil and
inadvertently ingested
Threadworms
is the most prevalent helminthic infection. It
may occur wherever sanitation is poor
ascaris
The larvae penetrate the skin and
then enter the blood and within about a week reach the intestine
Hookworm
are segmented flatworms with a head, or scolex, and a variable
number of segments that grow from the head
Cestodes
enter the body as
larvae that are found in undercooked meat or fish; they sometimes form
worms that are several yards long.
Cestodes
is the disease caused by ingestion of the encysted larvae of the
roundworm, Trichinella spiralis, in undercooked pork
Trichinosis
refers to infection of the blood and tissues of healthy individuals
by worm embryos, which enter the body via insect bites
Filariasis
are worms that cause disease by invading the human body.
Helminths
are the most frequent cause of helminth infection in the
United States, and roundworms
Pinworms
are the most frequent
cause of helminth infections throughout the world.
Ascaris
is important for decreasing the stress and anxiety that
may occur when individuals are diagnosed with a worm minfestation
Patient teaching
act on metabolic pathways that are
present in the invading worm but are absent or significantly different in the
human host
anthelmintic drugs
To ensure effective treatment of pinworm infections, which
instruction would be most important to emphasize to the patient and
family?
a. Keeping nails long so cutting will not introduce more infection
b. Laundering undergarments, bed linens, and pajamas every day
c. Boiling all drinking water
d. Maintaining a clear liquid diet for at least 7 to 10 days
b. Laundering undergarments, bed linens, and pajamas every day
Which of the following would the nurse expect to assess in a patient
who is suspected of having an Ascaris infection?
a. Cough and signs of pulmonary infestation
b. Cardiac arrhythmias and low blood pressure
c. Seizures and disorientation
d. Bloody diarrhea and excessive vomiting
a. Cough and signs of pulmonary infestation
The nurse describes schistosomiasis to a group of students as an
infection caused by
a. a protozoan carried by a mosquito.
b. improperly cooked pork.
c. a fluke carried by a snail.
d. eating food contaminated by fecal material.
c. a fluke carried by a snail.
A patient has traveled to Egypt and come home with
schistosomiasis. The family is very concerned about spreading the
disease. Which information would be most helpful to teach the
family?
a. Strict hand washing will stop the spread of the disease.
b. Isolating the patient will be necessary to stop the spread of the
disease.
c. Carefully cooking all of the patient’s food will help to stop the
spread of the disease.
d. The snail needed for the life cycle of this worm does not live in
this climate.
d. The snail needed for the life cycle of this worm does not live in
this climate.
A patient is prescribed mebendazole. The nurse knows that this is
the most commonly used anthelmintic, being the drug of choice for
treating
a. pinworms, roundworms, whipworms, and hookworms.
b. trichinosis, flukes, cestodes, and hookworms.
c. pork tapeworm, threadworms, cestodes, and whipworms.
d. all stages of schistosomal infections.
a. pinworms, roundworms, whipworms, and hookworms.
Patient teaching regarding the use of anthelmintics should include
counseling about
a. the use of oral contraceptives.
b. maintenance of nutrition during therapy.
c. the use of oral anticoagulants.
d. cardiac drug effects
b. maintenance of nutrition during therapy.
Patients may experience anxiety about the diagnosis and treatment of
helminthic infections. Teaching may help to alleviate this anxiety
and should include
a. what they may experience if the worms are passed from the
body.
b. focus on the cleanliness of the home.
c. measures to isolate the organism in the home.
d. criticism of their personal hygiene practices.
a. what they may experience if the worms are passed from the
body.
are
designed to fight neoplasms, or cancers
antineoplastic agents
is a disease that can strike a person at any age. It remains second only
to coronary disease as the leading cause of death in the United States.
Cancer
are responsible for the
characteristics seen in cancer cells.
oncogenes
—a loss of
cellular differentiation and organization, which leads to a loss of their ability
to function normally
anaplasia
growing without the usual
homeostatic restrictions that regulate cell growth and control.
autonomy
traveling from the place of origin to develop new tumors in other areas of the
body where conditions are favorable for cell growth
metastasis,
Cancers can be divided into two groups:
solid tumors
and
hematological malignancies
tumors that originate
in epithelial cells
carcinomas
tumors that originate in the mesenchyme
and are made up of embryonic connective tissue cells
sarcomas
hair loss; a common adverse effect of many antineoplastic
drugs, which are more effective against rapidly multiplying cells, such
as those of hair follicles
alopecia:
loss of organization and structure; property of cancer cells
anaplasia:
the generation of new blood vessels; cancer cells release an
enzyme that will cause angiogenesis or the growth of new blood
vessels to feed the cancer cells
angiogenesis
drug used to combat cancer or the growth of
neoplasms
antineoplastic agent:
loss of the normal controls and reactions that inhibit growth
and spreading; property of cancer cells
autonomy:
a common adverse effect of many antineoplastic
drugs, which are more effective against rapidly multiplying cells,
bone marrow suppression
tumor that originates in epithelial cells
carcinoma:
bility to enter the circulatory or lymphatic system and travel
to other areas of the body that are conducive to growth and survival
metastasis
new or cancerous growth; occurs when abnormal cells have
the opportunity to multiply and grow
neoplasm
tumor that originates in the mesenchyme and is made up of
embryonic connective tissue cells
sarcoma:
an antiinflammatory drug,
is being studied in various cancer combination drug trials for this effect.
Celecoxib (Celebrex)
or hair loss, related to effects on the
hair follicles, may also occur
alopecia
may be hepatotoxic; increases the risk of hepatotoxicity
when taken with antineoplastics that are hepatotoxic
Echinacea
—inhibits blood clotting, which can cause problems after
surgery or with bleeding neoplasms
Ginkgo
may increase the effects of various estrogen hormones
and hormone modulators; advise patients taking such drugs to avoid
this herb
Saw palmetto
can greatly increase photosensitivity, which can
cause problems with patients who have received radiation therapy or
are taking drugs that cause other dermatological effects;
St. John’s wort
are drugs that kill cells as the process of
mitosis begins
Mitotic inhibitors
act on specific enzymes that are
needed for protein building by specific tumor cells
protein kinase inhibitors
Some properties of neoplastic cells are the same as the properties of
normal cells, including
a. anaplasia.
b. metastasis.
c. mitosis.
d. autonomy
c. mitosis
Carcinomas are tumors that originate in
a. mesenchyme.
b. bone marrow.
c. striated muscle.
d. epithelial cells.
d. epithelial cells.
The goal of traditional antineoplastic drug therapy is to
a. reduce the size of abnormal cell mass for immune system
destruction.
b. eradicate all of the abnormal cells that have developed.
c. destroy all cells of the originating type.
d. stimulate the immune system to destroy the neoplastic cells
a. reduce the size of abnormal cell mass for immune system
destruction.
Cancer can be a difficult disease to treat because
a. cells no longer progress through the normal cell cycle.
b. cells can fail to develop resistance to drug therapy.
c. cells remain dormant, emerging months to years later.
d. the exact cause of cancer is not known.
c. cells remain dormant, emerging months to years later.
Antineoplastic drugs destroy human cells. They are most likely to
cause cell death among healthy cells that
a. have poor cell membranes.
b. are rapidly turning over.
c. are in dormant tissues.
d. are across the blood–brain barrier.
b. are rapidly turning over.
Cancer treatment usually occurs in several different treatment
phases. In assessing the appropriateness of another round of
chemotherapy for a particular patient, the nurse would evaluate
which as most important?
a. Hair loss
b. Bone marrow function
c. Anorexia
d. Heart rate
b. Bone marrow function
It is important to explain to women that chemotherapeutic agents
should not be used during pregnancy because
a. the tendency to cause nausea and vomiting will be increased.
b. of potential serious adverse effects on the rapidly multiplying
cells of the fetus.
c. bone marrow toxicity could alter hormone levels.
d. patients may be weakened by the drug regimen.
b. of potential serious adverse effects on the rapidly multiplying
cells of the fetus
Cancer drugs are given in combination and over a period of time
because it is difficult to affect
a. slowly growing cells.
b. cells in the dormant phase of the cell cycle.
c. cells that multiply rapidly and go through the cell cycle quickly.
d. cells that have moved from their normal site in the body.
b. cells in the dormant phase of the cell cycle.
immunoglobulins; produced by B-cell plasma cells and
memory cells in response to a specific protein; react with that protein
to cause its destruction directly or through activation of the
inflammatory response
antibodies:
foreign protein
antigen
released from injured cells to stimulate the
inflammatory response through activation of various chemical
substances
arachidonic acid
a disorder that occurs when the body responds to
specific self-antigens to produce antibodies or cell-mediated responses
against its own cells
autoimmune disease:
lymphocytes programmed to recognize specific proteins; when
activated, these cells cause the production of antibodies to react with
that protein
B cells:
heat, one of the four cardinal signs of inflammation; caused by
activation of the inflammatory response
calor
: property of drawing neutrophils to an area
chemotaxis
series of cascading proteins that react with the
antigen–antibody complex to destroy the protein or stimulate an
inflammatory reaction
complement proteins:
pain, one of the four cardinal signs of inflammation; caused by
activation of the inflammatory response
dolor
first factor activated when a blood vessel or cell is
injured;
Hageman factor:
tissue hormone that is released in response to viral invasion;
blocks viral replication
interferon:
chemicals released by white blood cells (WBCs) to
communicate with other WBCs and to support the inflammatory and
immune reactions
interleukins:
system activated by Hageman factor as part of the
inflammatory response; includes bradykinin
kinin system:
white blood cells; can be neutrophils, basophils, or
eosinophils
leukocytes
white blood cells with large, varied nuclei; can be T cells or
B cells
lymphocytes
mature leukocytes that are capable of phagocytizing an
antigen (foreign protein); also called monocytes or mononuclear
phagocytes
macrophages
the genetic identification code
carried on a chromosome; produces several proteins or antigens that
allow the body to recognize cells as being self-cells
major histocompatibility complex
fixed basophils found in the respiratory and gastrointestinal
tracts and in the skin
mast cells
leukocyte-producing cells in the bone marrow that can
develop into neutrophils, basophils, eosinophils, monocytes, or
macrophages
myelocytes:
neutrophils and macrophages that are able to engulf and
digest foreign material
phagocytes:
he process of engulfing and digesting foreign organic
materials
phagocytosis:
fever-causing substance
pyrogen:
redness, one of the four cardinal signs of inflammation; caused by
activation of the inflammatory response
rubor
lymphocytes programmed in the thymus gland to recognize selfcells; may be effector T cells, helper T cells, or suppressor T cells
T cells:
swelling, one of the four cardinal signs of inflammation; caused
by activation of the inflammatory response
tumor
line the areas of the body that are exposed to external
influences but do not have the benefit of skin protection.
Mucous membranes
. In humans, the genetic identification code is
carried on a chromosome and is called
major histocompatibility
complex
are
located on the cell membrane and allow the body to recognize cells as being
self-cells
antigens
are the
key components of the immune system
lymphocytes
can develop into a number of different cell types that are
important in both the basic inflammatory response and the immune response.
myelocytes
When the body is injured or invaded by a pathogen,
neutrophils are rapidly produced and move to the site of the insult, a property
called
chemtaxis
are myelocytic leukocytes that are not capable of phagocytosis
Basophils
Basophils that are fixed and do not circulate are called
mast cells
are circulating myelocytic leukocytes whose exact function is not
understood.
Eosinophils
is the local reaction of the body to invasion or
injury.
inflammatory response
is responsible for activating at least
three systems in the body
Hageman factor
the
clotting cascade, which initiates blood clotting
kinin system
substance found in the local tissues,
which causes the precursor substance kininogen to be converted to
bradykinin and other kinins
kallikrein,
is the precursor to many substances called
autocoids, including cyclooxygenase, prostacyclin, and thromboxane.
Arachidonic acid
are chemicals that are secreted by cells that have been invaded
by viruses and possibly by other stimuli.
Interferons
are chemicals secreted by active leukocytes to influence
other leukocytes.
Interleukins
occurs when the body responds to specific selfantigens to produce antibodies or cell-mediated immune responses against its
own cells.
Autoimmune disease
Antibodies
a. are carbohydrates.
b. are secreted by activated T cells.
c. are not found in circulating gamma globulins.
d. are effective only against specific antigens
d. are effective only against specific antigens
B and T cells are similar in that they both
a. secrete antibodies.
b. play important roles in the immune response.
c. are activated in the thymus gland.
d. release cytotoxins to destroy cells
b. play important roles in the immune response.
Which of the following is not a cytokine?
a. Interleukin 2
b. Antibody
c. Tumor necrosis factor
d. Interferon
b. Antibody
As part of the nonspecific defense against infection,
a. blood flow and vascular permeability to proteins increase
throughout the circulatory system.
b. particles in the respiratory tract are engulfed by phagocytes.
c. B cells are released from the bone marrow.
d. neutrophils release lysosomes, heparin, and kininogen into the
extracellular fluid.
b. particles in the respiratory tract are engulfed by phagocytes.
B cells respond to an initial antigen challenge by
a. reducing in size.
b. immediately producing antigen-specific antibodies.
c. producing a large number of cells that are unlike the original B
cell.
d. producing new cells that become plasma cells and memory cell
d. producing new cells that become plasma cells and memory cell
Treating fevers remains a controversial subject because
a. fevers make people feel ill.
b. higher temperatures act as catalysts to many of the body’s
chemical reactions.
c. higher temperatures can suppress the body’s normal metabolism.
d. higher temperatures can alter the body’s hormone levels,
particularly that of progesterone.
b. higher temperatures act as catalysts to many of the body’s
chemical reactions.
After describing the function of T cells, the nurse would identify the
need for additional teaching if the patient stated that T cells become
which type of cells?
a. Cytotoxic T cells
b. Helper T cells
c. Suppressor T cells
d. Antibody-secreting T cells
d. Antibody-secreting T cells
Interleukins are
a. chemicals released when a virus enters a cell.
b. chemicals secreted by activated leukocytes.
c. part of the kinin system.
d. activated by arachidonic acid.
b. chemicals secreted by activated leukocytes.
compound with pain-blocking properties, capable of producing
analgesia
analgesic:
drugs that block the effects of the
inflammatory response
antiinflammatory agents:
blocking fever, often by direct effects on the
thermoregulatory center in the hypothalamus or by blockade of
prostaglandin mediators
antipyretic:
treatment with gold salts; gold is taken up by
macrophages, which then inhibit phagocytosis; it is reserved for use in
patients who are unresponsive to conventional therapy, and can be very
toxic
chrysotherapy
the body’s nonspecific response to cell injury,
resulting in pain, swelling, heat, and redness in the affected area
inflammatory response:
drugs that block
prostaglandin synthesis and act as antiinflammatory, antipyretic, and
analgesic agents
nonsteroidal antiinflammatory drugs (NSAIDs):
salicylic acid compounds, used as antiinflammatory,
antipyretic, and analgesic agents; they block the prostaglandin system
salicylates:
syndrome associated with high levels of salicylates—
dizziness, ringing in the ears, difficulty hearing, nausea, vomiting,
diarrhea, mental confusion, and lassitude
salicylism:
A drug could be classified as an analgesic if it
a. reduces fever.
b. reduces swelling.
c. reduces redness.
d. reduces pain
d. reduces pain
An antipyretic is a drug that can
a. block pain.
b. block swelling.
c. block fever.
d. block inflammation.
c. block fever.
A nurse might not see a salicylate used as an antiinflammatory if a
drug was needed for its
a. antipyretic properties.
b. analgesic properties.
c. OTC availability.
d. parenteral availability
d. parenteral availability
The nonsteroidal NSAIDs affect the COX-1 and COX-2 enzymes.
By blocking COX-2 enzymes the NSAIDs block inflammation and
the signs and symptoms of inflammation at the site of injury or
trauma. By blocking COX-1 enzymes, these drugs block
a. fever regulation.
b. prostaglandins that protect the stomach lining.
c. swelling in the periphery.
d. liver function
b. prostaglandins that protect the stomach lining.
Your patient has been receiving ibuprofen for many years to relieve
the pain of osteoarthritis. Assessment of the patient should include
a. an electrocardiogram.
b. CBC with differential.
c. respiratory auscultation.
d. renal evaluation.
d. renal evaluation.
Patients taking NSAIDs should be taught to avoid the use of OTC
medications without checking with their prescriber because
a. many of the OTC preparations contain NSAIDs, and inadvertent
toxicity could occur.
b. no one should take more than one type of pain reliever at a time.
c. increased GI upset could occur.
d. there is a risk of Reye syndrome
a. many of the OTC preparations contain NSAIDs, and inadvertent
toxicity could occur.
Chronic or excessive activity by the inflammatory response can lead
to
a. loss of white blood cells.
b. coagulation problems.
c. release of lysosomal enzymes and tissue destruction.
d. adrenal suppression
c. release of lysosomal enzymes and tissue destruction.
A patient with rheumatoid arthritis who is on a fixed income and
who is being treated with aspirin should be advised
a. to use only brand name aspirin.
b. to use only enteric-coated aspirin.
c. to use generic aspirin.
d. to switch to one of the NSAIDs.
c. to use generic aspirin.
drug used to energize the immune system when it is
exhausted from fighting prolonged invasion or needs help fighting a
specific pathogen or cancer cell
immune stimulant
drug used to block or suppress the actions of the T
cells and antibody production; used to prevent transplant rejection and
to treat autoimmune diseases
immune suppressant
specific antibodies produced by a single clone of
B cells to react with a very specific antigen
monoclonal antibodies
use of bacteria to produce chemicals
normally produced by human cells
recombinant DNA technology
used to energize the immune
system when it is exhausted from fighting prolonged invasion or when the
immune system needs help fighting a specific pathogen or cancer cell.
immune stimulants
are used to block the normal effects of the immune
system in cases of organ transplantation
immune suppresants
substances naturally produced and released by human cells
that have been invaded by viruses.
interferons
antibodies
produced by a single clone of B cells that react with specific antigens.
monoclonal antibodies—
block the release of various cytokines involved in
the inflammatory response and activation of lymphocytes, decreasing
immune activity.
immune modulators
stimulate cellular immunity and inhibit tumor growth; they
are used to treat very specific cancers.
Interleukins
In which situation would the nurse least likely expect to administer
an immune suppressant?
a. Treatment of transplant rejection
b. Treatment of autoimmune disease
c. Reduction of number of relapses in multiple sclerosis
d. Treatment of aggressive cancers
d. Treatment of aggressive cancers
The nurse would expect to administer interferon alfa-n3 (Alferon N)
as the drug of choice for
a. treatment of leukemias.
b. treatment of multiple sclerosis.
c. intralesional treatment of warts.
d. treatment of Kaposi sarcoma.
c. intralesional treatment of warts.
Patient teaching for a patient receiving an interferon would include
a. proper use of oral contraceptives.
b. use of aspirin to control adverse effects.
c. importance of cardiovascular workouts.
d. proper methods injecting the drug.
d. proper methods injecting the drug.
Patients who are receiving an immune stimulant may experience any
of the clinical signs of immune response activity, including
a. flu-like symptoms.
b. diarrhea.
c. constipation.
d. headache.
a. flu-like symptoms.
Organ transplants are often rejected by the body because the T cells
recognize the transplanted cells as foreign and try to destroy them.
Treatment with an immune suppressant would
a. activate antibody production.
b. stimulate interleukin release.
c. stimulate thymus secretions.
d. block the initial damage to the transplanted cells.
d. block the initial damage to the transplanted cells.
You might use a monoclonal antibody in treating
a. warts.
b. herpes zoster.
c. tumors that overexpress HER2.
d. Kaposi sarcoma.
c. tumors that overexpress HER2.
the formation of antibodies secondary to exposure to a
specific antigen; leads to the formation of plasma cells, antibodies, and
memory cells to immediately produce antibodies if exposed to that
antigen in the future; imparts lifelong immunity
active immunity:
immune sera that contain antibodies to specific toxins
produced by invaders; may prevent the toxin from adhering to body
tissues and causing disease
antitoxins:
immune sera that contain antibodies to specific venins
produced by poisonous snakes or spiders; may prevent the venom from
causing cell death
antivenins:
vaccines, immune sera, and antitoxins that are used to
stimulate the production of antibodies, to provide preformed antibodies
to facilitate an immune reaction, or to react specifically with the toxins
produced by an invading pathogen
biological:
preformed antibodies found in immune globulin from
animals or humans who have had a specific disease and developed
antibodies to it
immune sera:
the injection of preformed antibodies into a host at
high risk for exposure to a specific disease; immunity is limited by the
amount of circulating antibody
passive immunity:
reaction of a host to injected antibodies or foreign sera;
host cells make antibodies to the foreign proteins, and a massive
immune reaction can occur
serum sickness:
immunization containing weakened or altered protein antigens to
stimulate a specific antibody formation against a specific disease;
refers to a product used to stimulate active immunity
vaccine:
Vaccines and immune sera, including antivenins and antitoxins, are usually
referred to as _______
biologicals.
occurs when the body recognizes a foreign protein and
begins producing antibodies to react with that specific protein or antigen.
Active immunity
occurs when preformed antibodies are injected into
the system and react with a specific antigen.
Passive immunity
a
massive immune reaction manifested by fever, arthritis, flank pain, myalgia,
and arthralgia
serum sickness,
is the process of artificially stimulating active immunity by
exposing the body to weakened or less toxic proteins associated with specific
disease-causing organisms.
immunizations
provide preformed antibodies to specific proteins for
people who have been exposed to them or are at high risk for exposure.
Immune sera
When preparing a presentation for a local parent group about
vaccines, the nurse would describe vaccines as being used to
stimulate
a. passive immunity to a foreign protein.
b. active immunity to a foreign protein.
c. serum sickness.
d. a mild disease in healthy people.
b. active immunity to a foreign protein.
After teaching a parent about common adverse effects associated
with routine immunizations, which of the following, if stated by the
parent, would indicate the need for additional teaching?
a. Difficulty breathing and fainting
b. Fever and rash
c. Drowsiness and fretfulness
d. Swelling and nodule formation at the site of injection
a. Difficulty breathing and fainting
Which vaccine would the nurse be least likely to recommend for a 6-
month-old child?
a. Diphtheria, tetanus, pertussis vaccine
b. Haemophilus influenzae b vaccine
c. Poliovirus vaccine
d. Chickenpox vaccine
d. Chickenpox vaccine
It is now recommended that all people over the age of 6 months
should receive a flu vaccine every fall based on the understanding
that the vaccine is repeated because
a. the immunity wears off after a year.
b. the strains of virus predicted to cause the flu change every year.
c. a booster shot will activate the immune system.
d. flu shots do not produce good antibodies.
b. the strains of virus predicted to cause the flu change every year.
The nurse reviews a patient’s record to make sure that tetanus
booster shots have been given
a. only with exposure to anaerobic bacteria.
b. every 2 years.
c. every 5 years.
d. every 10 years
d. every 10 years
A nurse suffers a needlestick after injecting a patient with suspected
hepatitis B. The nurse should
a. have repeated titers to determine whether she was exposed to
hepatitis B and if she was have hepatitis immune globulin.
b. immediately receive hepatitis immune globulin and begin
hepatitis B vaccines if she has not already received them.
c. start antibiotic therapy immediately.
d. go on sick leave until all screening tests are negative.
b. immediately receive hepatitis immune globulin and begin
hepatitis B vaccines if she has not already received them.
A patient is to receive immune globulin after exposure to hepatitis
A. The patient has a previous history of allergies to various drugs.
Before giving the immune globulin, the nurse should
a. have emergency equipment readily available.
b. premedicate the patient with aspirin.
c. make sure all of the patient’s vaccinations are up to date.
d. make sure the patient has a ride home.
a. have emergency equipment readily available.
sudden change in electrical charge of a nerve cell
membrane; the electrical signal by which neurons send information
action potential:
neurons or groups of neurons that bring information to the
central nervous system; sensory nerve
afferent:
long projection from a neuron that carries information from one
nerve to another nerve or effector
axon
short projection on a neuron that transmits information
dendrite
opening of the sodium channels in a nerve membrane to
allow the influx of positive sodium ions, reversing the membrane
charge so it is no longer polarized
depolarization
cell stimulated by a nerve; may be a muscle, a gland, or
another nerve cell
effector cell
neurons or groups of neurons that carry information from the
central nervous system to an effector; motor neurons are ____
efferent
short-term memory made up of a reverberating electrical circuit
of action potentials
engram
upper level of the brain; consists of the two cerebral
hemispheres, where thinking and coordination of sensory and motor
activity occur, contains the hypothalamus and thalamus and the area of
the limbic system
forebrain
a group of nerve bodies
ganglia
: most primitive area of the brain, the brainstem; consists of the
pons and medulla, which control basic, vital functions, and the
cerebellum, which controls motor functions that regulate balance
hindbrain
area in the forebrain that is rich in epinephrine,
norepinephrine, and serotonin and seems to control emotions
limbic system
area in the forebrain that is rich in epinephrine,
norepinephrine, and serotonin and seems to control emotions
midbrain
structural unit of the nervous system
neuronn
chemical produced by a nerve and released when the
nerve is stimulated; reacts with a specific receptor site to cause a
reaction
neurotransmitter
return of a membrane to a resting state, with more sodium
ions outside the membrane and a relatively negative charge inside the
membrane
repolarization
insulating cell found on nerve axons; allows “leaping”
electrical conduction to speed the transmission of information and
prevent tiring of the neuronsc
schwann cell
cell body of a neuron; contains the nucleus, cytoplasm, and various
granules
soma
junction between a nerve and an effector; consists of the
presynaptic nerve ending, a space called the synaptic cleft, and the
postsynaptic cell
synapse
fibers are nerve axons that
run from peripheral receptors into the CNS
afferent
fibers are
nerve axons that carry nerve impulses from the CNS to the periphery to
stimulate muscles or glands.
efferent
groups of nerve bodies
ganglia
Nerves send messages by conducting electrical impulses called ______
action
potentials.
that the sodium channels open in response to the stimulus, and sodium ions
rush into the cell, following the established concentration gradient.
depolarization
sodium–potassium pump, the cell then returns that
section of membrane to the resting membrane potential, a process called
repolarization
stimulate postsynaptic cells either by exciting or by
inhibiting them.
Neurotransmitters
is responsible for the expression of emotion,
and the thalamus and hypothalamus coordinate internal and external
responses and direct information into the cerebral cortex.
limbic system
The cerebellum
a. initiates voluntary muscle movement.
b. helps regulate the tone of skeletal muscles.
c. if destroyed, would result in the loss of all voluntary skeletal
activity.
d. contains the centers responsible for the regulation of body
temperature
b. helps regulate the tone of skeletal muscles
At those regions of the nerve membrane where myelin is present,
there is
a. low resistance to electrical current.
b. high resistance to electrical current.
c. high conductance of electrical current.
d. energy loss for the cell.
b. high resistance to electrical current
The nerve synapse
a. is not resistant to electrical current.
b. cannot become exhausted.
c. has a synaptic cleft.
d. transfers information at the speed of electricity.
c. has a synaptic cleft.
Which could result in the initiation of an action potential?
a. Depolarizing the membrane
b. Decreasing the extracellular potassium concentration
c. Increasing the activity of the sodium–potassium active transport
system
d. Stimulating the nerve with a threshold electrical stimulus during
the absolute refractory period of the membrane
a. Depolarizing the membrane
Neurotransmitters are
a. produced in the muscle to communicate with nerves.
b. the chemicals used to stimulate or suppress effectors at the nerve
synapse.
c. usually found in the diet.
d. nonspecific in their action on various nerves.
b. the chemicals used to stimulate or suppress effectors at the nerve
synapse.
The limbic system is an area of the brain that
a. is responsible for coordination of movement.
b. is responsible for the special senses.
c. is responsible for the expression of emotions.
d. controls sleep.
c. is responsible for the expression of emotions.
The most primitive area of the brain, the brainstem, contains areas
responsible for
a. vomiting, swallowing, respiration, arousal, and sleep.
b. learning.
c. motivation and memory.
d. taste, sight, hearing, and balance
a. vomiting, swallowing, respiration, arousal, and sleep.
A clinical indication of poor blood supply to the brain, particularly
to the higher levels where learning takes place, would be
a. loss of long-term memory.
b. loss of short-term memory.
c. loss of coordinated movement.
d. insomnia.
b. loss of short-term memory
unpleasant feeling of tension, fear, or nervousness in response to
an environmental stimulus, whether real or imaginary
anxiety
drug used to depress the central nervous system (CNS);
prevents or reduces the signs and symptoms of anxiety
anxiolytic:
former mainstay class of drug used for the treatment of
anxiety and for sedation and sleep induction;
barbiturate:
class of drug that acts in the limbic system and the
reticular activating system to make gamma-aminobutyric acid
(GABA),
benzodiazepine
extreme sedation resulting in CNS depression and sleep
hypnosis:
drug used to depress the CNS; causes sleep
hypnotic:
loss of awareness of and reaction to environmental stimuli
sedation
drug that depresses the CNS; produces a loss of awareness of
and reaction to the environment
sedative
once called minor tranquilizers, are drugs used to treat
anxiety by depressing the CNS.
Anxiolytics
Drugs that are best used to cause a patient to sleep are called
a. hypnotics.
b. sedatives.
c. antiepileptics.
d. anxiolytics.
a. hypnotics.
The benzodiazepines are the most frequently used anxiolytic drugs
because
a. they are anxiolytic at doses much lower than those needed for
sedation or hypnosis.
b. they can also be stimulating.
c. they are more likely to cause physical dependence than older
anxiolytic drugs.
d. they do not affect any neurotransmitters
a. they are anxiolytic at doses much lower than those needed for
sedation or hypnosis.
Barbiturates cause liver enzyme induction, which could lead to
a. rapid metabolism and loss of effectiveness of other drugs
metabolized by those enzymes.
b. increased bile production.
c. CNS depression.
d. the need to periodically lower the barbiturate dose to avoid
toxicity
a. rapid metabolism and loss of effectiveness of other drugs
metabolized by those enzymes.
A person who could benefit from an anxiolytic drug for short-term
treatment of insomnia would not be prescribed
a. zolpidem.
b. zaleplon.
c. buspirone.
d. meprobamate.
c. buspirone.
Anxiolytic drugs block the awareness of and reaction to the
environment. This effect would not be beneficial
a. to relieve extreme fear.
b. to moderate anxiety related to unknown causes.
c. in treating a patient who must drive a vehicle for a living.
d. in treating a patient who is experiencing a stress reaction.
c. in treating a patient who must drive a vehicle for a living.
Mr. Jones is the chief executive officer of a large company and has
been experiencing acute anxiety attacks. His physical examination
was normal, and he was diagnosed with anxiety. Considering his
occupation and his need to be alert and present to large groups on a
regular basis, which anxiolytic would be the drug of choice for Mr.
Jones?
a. Phenobarbital
b. Diazepam
c. Clorazepate
d. Buspirone
d. Buspirone
The benzodiazepines react with
a. GABA receptor sites in the RAS to cause inhibition of neural
arousal.
b. norepinephrine receptor sites in the sympathetic nervous system.
c. acetylcholine receptor sites in the parasympathetic nervous
system.
d. monoamine oxidase to increase norepinephrine breakdown.
a. GABA receptor sites in the RAS to cause inhibition of neural
arousal.
A pediatric patient is prescribed phenobarbital preoperatively to
relieve anxiety and produce sedation. After giving the injection, you
should assess the patient for
a. acute Stevens-Johnson syndrome.
b. bone marrow depression.
c. paradoxical excitement.
d. withdrawal syndrome.
c. paradoxical excitement.
feeling that a person experiences when he or she responds
emotionally to the environment
affect:
one of the neurotransmitters norepinephrine, serotonin,
or dopamine; it is thought that a deficiency of these substances in key
areas of the brain results in depression
biogenic amine:
affective disorder in which a person experiences sadness that
is much more severe and longer lasting than is warranted by the event
that seems to have precipitated it, with a more intense mood
depression:
drug that prevents the enzyme
monoamine oxidase from breaking down norepinephrine (NE),
serotonin (5HT), and dopamine (DA), leading to increased
neurotransmitter levels in the synaptic cleft; relieves depression and
also causes sympathomimetic effects
monoamine oxidase inhibitor (MAOI)
drug that specifically
blocks the reuptake of serotonin and increases its concentration in the
synaptic cleft; relieves depression and is not associated with
anticholinergic or sympathomimetic adverse effects
selective serotonin reuptake inhibitor (SSRI)
drug that increases both
serotonin and norepinephrine concentrations in synaptic cleft; relieves
depression with varying serotonergic or noradrenergic activity
serotonin norepinephrine inhibitors (SNRIs):
drug that blocks the reuptake of
norepinephrine and serotonin; relieves depression and has
anticholinergic and sedative effects
tricyclic antidepressants (TCAs):
an amine found in food that causes vasoconstriction and raises
blood pressure;
tyramine
The biogenic amine theory of depression states that depression is a
result of
a. an unpleasant childhood.
b. gamma-aminobutyric acid (GABA) inhibition.
c. deficiency of NE, dopamine, or 5HT in key areas of the brain.
d. blockages within the limbic system, which controls emotions and
affect.
c. deficiency of NE, dopamine, or 5HT in key areas of the brain.
When teaching a patient receiving TCAs, it is important to
remember that TCAs are associated with many anticholinergic
adverse effects. Teaching about these drugs should include
anticipation of
a. increased libido and increased appetite.
b. polyuria and polydipsia.
c. urinary retention, arrhythmias, and constipation.
d. hearing changes, cataracts, and nightmares.
c. urinary retention, arrhythmias, and constipation.
Adverse effects may limit the usefulness of TCAs with some
patients. Nursing interventions that could alleviate some of the
unpleasant aspects of these adverse effects include
a. always administering the drug when the patient has an empty
stomach.
b. reminding the patient not to void before taking the drug.
c. increasing the dose to override the adverse effects.
d. taking the major portion of the dose at bedtime to avoid
experiencing drowsiness and the unpleasant anticholinergic
effects
d. taking the major portion of the dose at bedtime to avoid
experiencing drowsiness and the unpleasant anticholinergic
effects
You might question an order for a MAOI as a first step in the
treatment of depression remembering that these drugs are reserved
for use in cases in which there has been no response to other agents
because MAOIs
a. can cause hair loss.
b. are associated with potentially serious drug–food interactions.
c. are mostly recommended for use in surgical patients.
d. are more expensive than other agents.
b. are associated with potentially serious drug–food interactions.
Your patient is being treated for depression and is started on a
regimen of fluoxetine (Prozac). She calls you 10 days after the drug
therapy has started to report that nothing has changed and she wants
to try a different drug. You should
a. tell her to try sertraline (Zoloft) because some patients respond to
one SSRI and not another.
b. ask her to try a few days without the drug to see whether there is
any difference.
c. add an MAOI to her drug regimen to get an increased
antidepressant effect.
d. encourage her to keep taking the drug as prescribed because it
usually takes up to 4 weeks to see the full antidepressant effect.
d. encourage her to keep taking the drug as prescribed because it
usually takes up to 4 weeks to see the full antidepressant effect.
Which of the following medications is NOT indicated for obsessive–
compulsive disorder, depression, and panic disorder?
a. citalopram (Celexa)
b. paroxetine (Paxil)
c. fluvoxamine (Luvox)
d. vortioxetine (Brintellix)
d. vortioxetine (Brintellix)
Venlafaxine (Effexor) is an antidepressant that might be very
effective for use in patients who
a. are being treated effectively with a SSRI.
b. can tolerate multiple side effects.
c. are reliable at taking multiple daily dosings.
d. have not responded to other antidepressants and would benefit
from once-a-day dosing
d. have not responded to other antidepressants and would benefit
from once-a-day dosing
Depression is an affective disorder that is
a. always precipitated by a specific event.
b. most common in patients with head injuries.
c. characterized by overwhelming sadness, despair, and
hopelessness.
d. very evident and easy to diagnose in the clinical setting.
c. characterized by overwhelming sadness, despair, and
hopelessness.
