Pharmacology Flashcards
1
Q
What are the primary uses of psyllium?
A
To treat constipation and chronic watery diarrhea by increasing stool bulk, softening stool, retaining water, and promoting bowel movement.
2
Q
How does psyllium help in cases of watery diarrhea?
A
It absorbs excess water and helps form firmer stools.
3
Q
What is the mechanism of action of psyllium?
A
It is a natural fibrous agent that absorbs water into the intestine, stimulates peristalsis, and normalizes bowel function.
4
Q
What are common side effects of psyllium?
A
Nausea, vomiting, abdominal cramps, and flatulence.
5
Q
What are serious adverse reactions to psyllium?
A
Gastrointestinal obstruction, bronchospasm, and anaphylaxis.
6
Q
What is a critical patient teaching point about how to take psyllium?
A
Take with a full glass of water followed by another glass to prevent choking or esophageal obstruction. Never take dry.
7
Q
What should patients do when preparing psyllium powder?
A
Mix the powder in 8–10 oz of water and drink it immediately.
8
Q
What lifestyle modifications should be encouraged with psyllium use?
A
Increase fluid and fiber intake and engage in daily exercise to support bowel regularity.
9
Q
What should patients be warned not to do when using psyllium powder?
A
Do not inhale the powder, as it may cause respiratory symptoms like runny nose, watery eyes, or wheezing.
10
Q
When should a patient stop taking psyllium and notify a healthcare provider?
A
If they experience nausea, vomiting, cramps, rectal bleeding, or have difficulty swallowing or signs of obstruction.
11
Q
What are the primary uses of ondansetron (Zofran)?
A
It is used to treat nausea and vomiting, especially related to chemotherapy, postoperative recovery, and radiation therapy.
12
Q
When should ondansetron be administered in chemotherapy patients?
A
It should be given before chemotherapy begins, not after vomiting starts.
13
Q
Through which routes can ondansetron be administered?
A
PO (oral), IV (intravenous), and IM (intramuscular).
14
Q
What is the mechanism of action of ondansetron?
A
It blocks serotonin (5-HT3) receptors in the chemoreceptor trigger zone (CTZ) and vomiting center of the brain.
15
Q
What are common central nervous system side effects of ondansetron?
A
Dizziness, drowsiness, agitation, headache, fatigue, and malaise.
16
Q
What are common gastrointestinal or systemic side effects of ondansetron?
A
Diarrhea, constipation, hypotension, urinary retention, and fever.
17
Q
What are the primary uses of promethazine (Phenergan)?
A
To prevent or treat motion sickness, nausea, vomiting, and for sedation. Commonly used in the Post-Anesthesia Care Unit (PACU).
18
Q
What is the mechanism of action of promethazine?
A
It has antihistamine and anticholinergic properties, blocking H1 and acetylcholine receptors in the vomiting center.
19
Q
Why is promethazine contraindicated in children under 2 years old?
A
Due to the risk of respiratory depression.
20
Q
Why is promethazine contraindicated in patients with glaucoma?
A
Because of its anticholinergic effects, which can increase intraocular pressure.
21
Q
What central nervous system side effects can promethazine cause?
A
Drowsiness, confusion, and dizziness.
22
Q
What are the common anticholinergic side effects of promethazine?
A
Dry mouth, blurred vision, constipation, urinary retention, tachycardia, photosensitivity, and hyperthermia.
23
Q
What are possible injection-related side effects of promethazine?
A
Injection site reactions and skin discoloration.
24
Q
What is an important drug interaction concern with promethazine?
A
It is sedating and can increase the effects of CNS depressants like opioids.
25
What are key nursing responsibilities when administering promethazine IV?
Avoid IV if possible. If necessary, administer slowly in a large bore vein to reduce risk of tissue damage.
26
What should nurses monitor when a patient is on promethazine?
Monitor for oliguria, hyperthermia, and vision changes.
27
What should be included in patient education for promethazine?
Stay hydrated, wear sunglasses for photosensitivity, and avoid extreme heat due to anticholinergic effects.
28
What are common causes of diarrhea?
Contaminated or spoiled food, infections (bacterial or viral), malabsorption, laxative abuse, stress, inflammatory bowel disease (IBD), and certain medications.
29
What are potential complications of diarrhea, especially in vulnerable populations?
Dehydration and electrolyte imbalances, particularly dangerous in children and older adults.
30
What types of foods should be avoided during diarrhea episodes?
Milk, dairy products, and fatty foods.
31
What types of fluids are recommended to manage dehydration in diarrhea?
Clear liquids such as broth and oral rehydration solutions.
32
What diet is commonly recommended to help manage diarrhea?
The BRAT diet: Bananas, Rice, Applesauce, and Toast.
33
What lifestyle measure should be taken to help manage or prevent diarrhea recurrence?
Identify and eliminate trigger foods (e.g., caffeine, spicy food), and monitor hydration status, especially in children and older adults.
34
What is the primary use of diphenoxylate with atropine (Lomotil)?
To treat diarrhea by slowing intestinal motility.
35
What is the function of each component in Lomotil?
Diphenoxylate: An opioid that slows GI motility
Atropine: An anticholinergic added to discourage abuse.
36
What is the route of administration for Lomotil?
Oral (PO)
37
What is the mechanism of action of diphenoxylate with atropine?
Acts on the smooth muscle of the GI tract to reduce peristalsis.
38
What should nurses monitor when a patient is on Lomotil?
Bowel sounds for hyperactivity
Stool frequency and consistency
Signs of dehydration or electrolyte imbalance
Respiratory rate (due to CNS depression risk).
39
What patient history factors should be assessed before administering Lomotil?
History of narcotic use, liver disease, ulcerative colitis, or glaucoma.
40
What are key patient teaching points for Lomotil?
Do not use for more than 2 days or if fever is present
Avoid alcohol, OTC antidiarrheals, and other CNS depressants
May cause euphoria or dependency
Encourage hydration and avoid fried foods and dairy
Report abdominal pain, continued diarrhea, or symptoms >48 hours.
41
What are common side effects of Lomotil?
Drowsiness, dizziness, dry mouth, constipation, nausea, and euphoria.
42
What are serious adverse effects of Lomotil?
Respiratory depression, toxic megacolon, anaphylaxis, and ileus.
43
What is a key patient instruction regarding how to take H2 blockers?
Take the medication exactly as prescribed for full effectiveness.
44
Why should patients avoid smoking while taking H2 blockers?
Smoking reduces the drug’s efficacy.
45
How should iron supplements be timed with H2 blocker use?
Separate iron supplements and H2 blockers (e.g., famotidine) by at least 1 hour, since stomach acid is needed for optimal iron absorption.
46
What types of foods and drinks should be avoided when taking H2 blockers?
Alcohol, caffeine, and spicy foods — as they can irritate the stomach lining.
47
Why is Vitamin B12 supplementation or B12-rich food encouraged with H2 blockers?
H2 blockers reduce stomach acid, which decreases Vitamin B12 absorption.
48
What should patients know about H2 blockers and erectile dysfunction?
Drug-induced erectile dysfunction is reversible upon discontinuation.
49
What are common side effects of H2 blockers?
Headache, dizziness, drowsiness, confusion, insomnia, nausea, vomiting, diarrhea, constipation, depression, rash, fatigue, muscle cramps, and erectile dysfunction.
50
What are possible adverse reactions to H2 blockers?
Palpitations, gynecomastia, Vitamin B12 deficiency.
51
What are the life-threatening reactions associated with H2 blockers?
Anaphylaxis, agranulocytosis, leukopenia, thrombocytopenia, pancytopenia, dysrhythmia, and bronchospasm.
52
What conditions are treated with PPIs?
GERD, duodenal ulcers, esophagitis, H. pylori infection, Zollinger-Ellison syndrome, and NSAID-induced ulcers.
53
What is the mechanism of action of PPIs?
PPIs suppress gastric acid secretion by blocking the hydrogen/potassium ATPase enzyme in gastric parietal cells.
54
How do PPIs affect digoxin and similar drugs?
PPIs reduce the absorption of digoxin, ampicillin, and ketoconazole. However, abruptly stopping PPIs can cause a spike in digoxin levels, increasing toxicity risk.
55
What happens when PPIs are used with statins?
Statin levels may increase, potentially raising the risk of side effects.
56
What electrolyte imbalance can result from combining PPIs with diuretics, ACE inhibitors, or ARBs?
Hypomagnesemia.
57
What are symptoms of hypomagnesemia?
Muscle cramps, irregular heartbeat, tingling sensations, and mood changes.
58
What are common side effects of PPIs?
Headache, dizziness, depression, dry mouth, constipation, diarrhea, and vitamin B12 deficiency.
59
What are adverse reactions associated with PPI use?
GI bleeding, hypomagnesemia, anemia, tachycardia, bone fractures, and angioedema.
60
What life-threatening conditions are linked to PPIs?
Clostridioides difficile-associated diarrhea (CDAD), Stevens-Johnson Syndrome, pancytopenia, and hepatic failure.
61
What nursing actions are important for patients on PPIs?
Report any diarrhea and abdominal cramping, as it may indicate CDAD.
## Footnote
Monitor bowel function and electrolyte levels.
62
Why is combination therapy used to treat H. pylori?
To prevent antibiotic resistance — single antibiotics are ineffective.
63
What are the components of Triple Therapy for H. pylori eradication?
Metronidazole (or Clarithromycin), Amoxicillin, Proton pump inhibitor (e.g., Omeprazole or Lansoprazole)
64
What drugs are included in Quadruple Therapy for H. pylori?
Bismuth subsalicylate, Tetracycline, Metronidazole, Proton pump inhibitor (PPI)
65
What is the typical duration of H. pylori treatment?
7 to 14 days.
66
Why is it important not to use a single antibiotic for H. pylori treatment?
Because of the high risk of bacterial resistance — monotherapy is ineffective.
67
What are common side effects of aluminum hydroxide?
Constipation and hypophosphatemia (due to phosphate binding).
68
What can result from long-term use of aluminum hydroxide?
Bone demineralization if phosphate depletion occurs.
69
What electrolyte levels should be monitored in patients taking aluminum hydroxide?
Phosphate and calcium levels.
70
Why should aluminum hydroxide be avoided in patients with renal failure?
Risk of aluminum accumulation and toxicity.
71
What additional risks should nurses monitor for in patients using aluminum hydroxide?
Electrolyte imbalances and rebound hyperacidity.
72
What are common side effects of magnesium hydroxide?
Diarrhea, flushing, and sweating.
73
What serious condition can occur with magnesium hydroxide use in patients with renal impairment?
Magnesium toxicity, which can cause muscle weakness, confusion, and cardiac irregularities.
74
What labs and functions should be monitored in patients taking magnesium hydroxide?
Renal function and serum magnesium levels.
75
Why should magnesium hydroxide not be taken with other oral medications?
It can interfere with the absorption of other drugs.
76
Why should patients avoid milk or foods high in vitamin D when taking magnesium hydroxide?
There is a risk of calcium-magnesium imbalance.
77
What symptoms should patients report when taking magnesium hydroxide?
Abdominal pain, vomiting of blood, or black/tarry stools (possible GI bleeding).
78
What is the mechanism of action of antacids?
They neutralize gastric acid by acting as an alkaline base; they do not coat ulcers, only reduce stomach acidity.
79
When should antacids be taken for maximum effectiveness?
1–3 hours after meals and at bedtime.
80
Why should antacids not be taken with other medications?
They can delay the absorption of other drugs, especially tetracycline, digoxin, and quinidine.
81
What foods should be avoided when taking antacids and why?
Milk and foods high in vitamin D — they can increase calcium levels, leading to rebound hyperacidity.
82
What is the proper technique for taking liquid antacid formulations?
Shake the bottle well and follow the dose with 2–4 oz of water.
83
What is the correct way to take chewable antacid tablets?
Chew thoroughly and follow with water.
84
Why should long-term use of antacids be avoided without provider consultation?
Because prolonged use can mask underlying conditions and lead to electrolyte imbalances or rebound symptoms.
85
What sleeping position is recommended for patients with GERD?
Elevate the head of the bed while sleeping.
86
How long should a person with GERD wait before lying down after eating?
At least 2–3 hours.
87
Why is weight loss recommended for GERD management?
Because excess weight increases abdominal pressure, which can worsen reflux symptoms.
88
What are common dietary triggers that should be avoided in GERD?
Caffeine, chocolate, alcohol, spicy foods, tomatoes, and carbonated beverages.
89
How should meals be adjusted for patients with GERD?
Eat smaller, more frequent meals instead of large ones.
90
What type of clothing should GERD patients avoid and why?
Tight-fitting clothing, as it can increase abdominal pressure and worsen reflux.
91
Why is smoking discouraged in patients with GERD?
Smoking weakens the lower esophageal sphincter, promoting acid reflux.
92
What is an important patient teaching point regarding NSAID use in GERD?
NSAIDs like ibuprofen should be taken with food to reduce gastric irritation.
93
What is the first step of the CJMM and what does it involve?
Recognize Cues — identifying relevant clinical data such as patient symptoms, vitals, labs, physical assessments, and chart information. It focuses on distinguishing what is normal vs. abnormal and urgent vs. expected.
94
What is the second step of the CJMM and its purpose?
Analyze Cues — organizing and interpreting the cues to determine relationships or patterns, like identifying possible complications or underlying causes (e.g., sepsis, fluid overload).
95
What is the third step in CJMM and what tools are used in this step?
Prioritize Hypotheses — evaluating and ranking problems based on urgency using tools like Maslow’s Hierarchy, ABCs, and acute vs. chronic prioritization.
96
What does the fourth step, “Generate Solutions,” focus on?
Determining potential interventions or actions, including independent nursing actions, collaboration with providers, or resource referrals.
97
What is involved in the fifth step, “Take Action”?
Implementing the selected interventions such as giving medications, calling the provider, elevating the HOB, or patient education.
98
What is the sixth and final step of the CJMM?
Evaluate Outcomes — assessing if interventions were effective, if goals were met, and identifying if new cues need to be addressed, continuing the judgment cycle.
99
What does Layer 0 of the CJMM represent?
Observed Behavior — what the nurse actually does, such as performing interventions or making decisions.
100
What is described in Layer 1 of the CJMM?
Clinical Judgment Steps — the six steps from recognizing cues to evaluating outcomes.
101
What factors are included in Layer 2 of the CJMM?
Influencing Factors — includes the environment, clinical experience, and personal attributes that impact decision-making.
102
What does Layer 3 of the CJMM evaluate?
The Nurse’s Overall Capacity — such as their knowledge base, clinical experience, and adherence to standards of practice.
103
What is an additive drug interaction?
When two drugs with similar actions produce a combined effect equal to the sum of their individual effects.
## Footnote
Equation: 1 + 1 = 2
104
What is a clinical example of an additive effect?
Aspirin + Acetaminophen: Both relieve pain without increasing side effects.
## Footnote
Diuretic + Beta Blocker: Used together to lower blood pressure more effectively.
105
What is a synergistic drug interaction?
When two drugs produce a combined effect greater than the sum of their individual effects.
## Footnote
Equation: 1 + 1 = >2
106
What is a clinical example of a synergistic effect?
Alcohol + Sedatives (e.g., diazepam): Can cause dangerous CNS depression.
## Footnote
Amoxicillin + Clavulanic Acid (Augmentin): Clavulanic acid enhances amoxicillin’s effectiveness by preventing bacterial resistance.
107
What is an antagonistic drug interaction?
When one drug reduces or blocks the effect of another.
## Footnote
Equation: 1 + 1 = <2
108
What is a clinical example of an antagonistic effect?
Naloxone (Narcan) + Opioids: Naloxone reverses the effects of opioid overdose.
## Footnote
Vitamin K + Warfarin: Vitamin K blocks warfarin’s anticoagulant effect.
109
What factors influence drug absorption in pediatric patients?
Age, weight, health status, and route of administration.
110
How is GI absorption different in neonates and infants?
Slower gastric emptying, irregular peristalsis and enzymatic activity, improves as the child grows.
111
How does body water composition affect drug distribution in neonates?
Neonates are ~75% water vs. adults ~60%, affecting water-soluble drug distribution.
112
How does low albumin in neonates impact drug distribution?
Decreased protein-binding = more free (active) drug = increased drug effect or toxicity risk.
113
What is the significance of an immature blood-brain barrier in neonates?
More drug can enter the CNS, increasing the risk of central nervous system effects.
114
Why is drug metabolism slower in infants?
Due to reduced hepatic enzyme activity and liver blood flow.
115
What is the role of the CYP450 system in pediatric drug metabolism?
It matures at different rates, affecting drug metabolism; genetic variations can cause variable responses.
116
By what age is hepatic metabolism generally similar to that of adults?
By around 1 year of age.
117
How is excretion affected in neonates?
Immature kidneys with GFR ~30% of adult levels lead to slower drug elimination and longer half-lives.
118
What risk does reduced renal function pose for neonates taking medications?
Higher risk of drug accumulation and toxicity if dosing isn't properly adjusted.
119
What pediatric developmental factors affect drug action?
Organ immaturity, altered receptor sensitivity, enzyme function, and drug-binding capabilities.
120
How should pediatric drug doses be calculated?
Based on weight (kg) or body surface area (BSA).
121
Why might therapeutic effects and side effects differ in children?
Due to developmental differences in organ systems and receptor function.
122
What is essential to consider when calculating pediatric medication doses?
Age-specific pharmacokinetics and using weight (kg) or BSA-based dosing.
123
Why should nurses differentiate between developmental and chronological age?
Developmental stage can influence drug response and cooperation with treatment.
124
What are key nursing responsibilities during pediatric drug administration?
Monitor for toxicity, provide age-appropriate education, use family-centered care, assess the child's understanding and ability to cooperate, be cautious with off-label medications.
125
How is drug absorption affected in older adults?
It is generally slowed due to reduced small-bowel surface area, decreased gastric blood flow and acid production, and delayed gastric emptying, which may affect drugs like calcium, iron, and B12.
126
What changes in body composition affect drug distribution in older adults?
↓ Lean muscle mass
↑ Body fat → ↑ volume of distribution for lipid-soluble drugs (e.g., diazepam)
↓ Total body water → ↑ concentration of water-soluble drugs (e.g., aminoglycosides)
↓ Serum albumin → ↑ free drug levels and toxicity risk.
127
How is liver metabolism altered in the elderly?
↓ Liver size and blood flow
↓ Cytochrome P450 activity
Result: prolonged half-life and slower drug clearance → ↑ risk of accumulation/toxicity.
## Footnote
LFTs may not reliably predict drug metabolism.
128
Why is renal drug excretion decreased in older adults?
Due to reduced renal blood flow, glomerular filtration rate (GFR), and tubular function, which slows drug clearance and increases toxicity risk.
129
Why might serum creatinine levels appear normal in older adults despite reduced kidney function?
Because of decreased muscle mass; creatinine clearance (CrCl) is a more accurate measure.
130
How is drug response altered in the elderly due to pharmacodynamics?
Due to altered receptor sensitivity, fewer receptors, or reduced binding capacity, leading to either increased or decreased drug effects.
131
Which types of drugs are older adults especially sensitive to?
CNS depressants (e.g., benzodiazepines → sedation, falls)
Anticholinergics (e.g., ↑ confusion, dry mouth, constipation, urinary retention).
132
What factors increase the risk of adverse drug reactions in older adults?
Polypharmacy
Drug-drug interactions
Slower drug clearance
Age-related organ decline.
133
What is the “start low, go slow” principle?
Begin with the lowest effective drug dose and titrate slowly to minimize side effects.
134
What are atypical signs of drug toxicity in older adults?
Confusion or behavioral changes rather than typical signs like fever or pain.
135
How does polypharmacy increase patient risk?
It increases the chances of drug-drug interactions, medication nonadherence, and hospitalizations.
136
What tool helps identify potentially inappropriate medications in the elderly?
The Beers Criteria.
137
What strategies can promote medication adherence in older adults?
Regular medication reviews
Pill organizers or medication calendars
Educating family or caregivers if cognitive decline is present.
138
What are signs of possible medication nonadherence in older adults?
Confusion, financial concerns, or difficulty managing complex medication regimens.
139
What does the acronym 'PINCH' stand for in high-alert medications?
P: Potassium & Electrolytes
I: Insulin
N: Narcotics/Opioids
C: Chemotherapy
H: Heparin/Anticoagulants
140
Why is potassium chloride (KCl) considered high-alert?
Overdose can cause life-threatening cardiac arrhythmias.
141
What makes insulin a high-alert medication?
Risk of hypoglycemia; requires independent double checks.
142
What are key risks associated with opioids like morphine and fentanyl?
Respiratory depression, sedation, and addiction.
143
What safety measures should be taken with chemotherapy drugs?
Use PPE and special handling protocols due to cytotoxicity.
144
Why is heparin considered a high-alert drug?
High risk of bleeding; requires PT/INR or aPTT monitoring.
145
Name other medication types that are high-alert beyond PINCH.
Sedatives (e.g., midazolam)
Neuromuscular blockers (e.g., succinylcholine)
TPN (Total Parenteral Nutrition)
146
What are the original 6 rights of medication administration?
Right Patient
Right Drug
Right Dose
Right Time
Right Route
Right Documentation
147
What are the newer, expanded rights of medication administration?
7. Right to Refuse
8. Right Assessment
9. Right Evaluation
10. Right Education
148
Why is the 'Right Assessment' important before administering a drug?
Ensures safe administration, e.g., checking BP before giving antihypertensives.
149
What’s the difference between a tablet and a caplet?
A caplet is an oval, coated tablet designed to be easier to swallow.
150
Why shouldn’t enteric-coated or extended-release (ER/SR) tablets be crushed?
Crushing alters absorption rate, risking toxicity or reduced effect.
151
What should be done before administering a suspension?
Shake well to evenly distribute the medication.
152
What is the main advantage of sublingual and buccal routes?
Rapid absorption directly into the bloodstream without first-pass metabolism.
153
Which route has the fastest onset of action?
Intravenous (IV)
154
What is important when giving drugs through an NG or PEG tube?
Verify placement and flush with water before and after administration.
155
Why should otic drops be warmed before administration?
To prevent dizziness and discomfort.
156
What’s a nursing precaution for transdermal patches?
Rotate application sites and avoid hairy or irritated skin.
157
What type of medications must never be crushed?
Enteric-coated tablets
Extended-release (XR, ER, SR)
Sublingual or buccal forms
158
What tool is used to help nurses identify unsafe drugs in older adults?
Beers Criteria
159
What are the primary therapeutic uses of folic acid (Vitamin B9)?
Treating megaloblastic and macrocytic anemia, preventing neural tube defects during pregnancy, and often used in preconception planning and early pregnancy.
160
What is the CDC's recommended daily dose of folic acid during pregnancy?
400 mcg daily
161
What are the available routes of administration for folic acid?
Oral (PO), intramuscular (IM), subcutaneous (SubQ), and intravenous (IV)
162
What is the mechanism of action of folic acid?
Stimulates production of red blood cells (RBCs), white blood cells (WBCs), and platelets.
163
What are important nursing responsibilities when teaching about folic acid?
Educate about folate-enriched foods (bread, cornmeal, rice, pasta, cereal). Caution that high folic acid intake can mask vitamin B12 deficiency, potentially worsening cognitive decline.
164
What are common side effects of folic acid?
Flushing, malaise, erythema, pruritus, skin rash.
165
What is a rare but serious side effect of folic acid?
Allergic bronchospasm.
166
What are the essential functions of Vitamin B12 (Cyanocobalamin)?
Nerve function, DNA synthesis, Red blood cell formation
167
What conditions can result from a Vitamin B12 deficiency?
Megaloblastic anemia, Neurological symptoms (e.g., numbness, tingling, cognitive changes)
168
What is a key nursing caution when administering folic acid in the presence of B12 deficiency?
Folic acid may correct the anemia but worsen neurologic symptoms if B12 deficiency is not treated.
169
Where in the GI tract is Vitamin B12 absorbed?
At the end of the ileum
170
What are the primary uses of iron supplements like ferrous sulfate or iron dextran?
Treatment and prevention of iron deficiency anemia and support for hemoglobin production.
171
How does pregnancy affect iron requirements?
Iron needs double during pregnancy; the CDC recommends 30 mg/day starting at the first prenatal visit.
172
What is the preferred route of iron administration, and when is iron dextran used?
Oral iron is preferred. Iron dextran is used IM or IV when oral iron is not tolerated or effective.
173
What method is used for IM iron dextran injection, and why?
The Z-track method, to prevent skin staining.
174
What are common GI side effects of oral iron?
Nausea, constipation, and dark/tarry stools.
175
What patient education is important for liquid iron supplements?
Dilute and drink with a straw to prevent tooth discoloration.
176
What enhances the absorption of oral iron?
Taking it on an empty stomach with vitamin C (e.g., orange juice).
177
What substances should be avoided when taking iron and why?
Milk, antacids, and calcium — they interfere with absorption.
178
How should iron supplements be stored?
In a light-resistant container and out of reach of children (risk of toxicity).
179
What lab result may be falsely affected by iron therapy?
Fecal occult blood test — may give a false-positive result.
180
What is the mechanism of action of adrenergic agonists?
They stimulate the sympathetic nervous system by activating alpha and beta adrenergic receptors.
181
What are common side effects of adrenergic agonists?
Tachycardia, Hypertension, Tremors, Restlessness, Hyperglycemia (especially in diabetics), Insomnia, Headache, nausea, vomiting.
182
What symptoms should patients report when taking adrenergic agonists?
Chest pain, tremors, or palpitations.
183
What OTC products should be avoided while on adrenergic agonists?
Decongestants or cold medications that may contain adrenergic agents.
184
What special considerations apply to diabetic patients taking adrenergic agonists?
They should monitor blood glucose closely due to risk of hyperglycemia.
185
What should patients avoid to reduce stimulant side effects from adrenergic agonists?
Caffeine and other stimulants.
186
What is the mechanism of action of adrenergic antagonists?
They block adrenergic receptor activity, reducing sympathetic nervous system effects.
187
What are common side effects of adrenergic blockers?
Bradycardia, Hypotension, Dizziness, Fatigue, Depression, Impotence, Orthostatic hypotension, Bronchospasm (with nonselective beta blockers).
188
Why should patients not stop adrenergic blockers abruptly?
It can cause rebound hypertension or angina.
189
What safety teaching should be given regarding position changes?
Rise slowly from sitting or lying to avoid orthostatic hypotension.
190
What should diabetic patients know about beta blockers?
Beta blockers may mask symptoms of hypoglycemia (e.g., tachycardia).
191
What lifestyle precautions should be taught during initial adrenergic blocker therapy?
Avoid alcohol, hot showers, or strenuous exercise initially, as these can worsen hypotension.
192
What emergency identification is recommended for patients on long-term adrenergic blocker therapy?
They should carry a medical alert ID.
193
What are the primary uses of methylphenidate?
Treatment of ADHD and narcolepsy.
194
What is the drug schedule classification of methylphenidate and what does it imply?
Schedule II controlled substance — high potential for abuse and dependence.
195
How does methylphenidate work?
It inhibits reuptake of norepinephrine and dopamine, increasing attention and focus, while decreasing hyperactivity and impulsivity.
196
When should methylphenidate be taken?
Before meals to enhance absorption and reduce GI upset; avoid evening doses to prevent insomnia.
197
What are common side effects of methylphenidate?
Anorexia, Dry mouth, Insomnia, Tachycardia, Irritability, Restlessness, Tremors.
198
What can be done to manage dry mouth from methylphenidate?
Use sugarless gum or candies.
199
What should patients monitor for regarding weight?
Check weight twice weekly and report significant weight loss.
200
What safety precautions should be taken while on methylphenidate?
Avoid driving if experiencing dizziness, tremors, or nervousness; taper off slowly to avoid withdrawal symptoms.
201
What substances should be avoided while taking methylphenidate?
Alcohol, Caffeine, OTC products containing caffeine (risk of toxic plasma levels).
202
Can breastfeeding mothers take methylphenidate? Why or why not?
No — the drug is excreted in breast milk and can cause restlessness in the infant.
203
What nutritional advice should be given to patients on methylphenidate?
Eat a nutritious breakfast; monitor for appetite suppression and growth delays in children.
204
What monitoring is required during methylphenidate therapy?
Vital signs (especially heart rate and blood pressure), Height and weight (in children), Signs of Tourette syndrome or tics.
205
Why is behavioral support important during methylphenidate therapy?
Because drug therapy alone is not enough — it should be combined with behavioral counseling and family/school support.
206
Who should be informed at school if a child is taking methylphenidate?
The school nurse — to monitor daytime effects and assist with care coordination.
207
What is the goal of antiseizure drug (AED) therapy?
To stabilize nerve membranes and suppress abnormal electrical impulses.
208
Do AEDs cure epilepsy?
No — they control symptoms, but do not cure the disorder.
209
When is AED therapy typically stopped?
Usually lifelong, but may be discontinued if seizure-free for 3–5 years.
210
Name three common classes of AEDs and an example of each.
Hydantoins: Phenytoin
Barbiturates: Phenobarbital, Primidone
Benzodiazepines: Diazepam, Clonazepam
211
What seizure types is phenytoin used to treat?
Tonic-clonic seizures
Partial seizures
Status epilepticus
212
What is the mechanism of action of phenytoin?
It inhibits sodium influx, stabilizing neuronal membranes.
213
What is status epilepticus?
A prolonged seizure (>5 minutes) or repeated seizures without recovery of consciousness — a medical emergency.
214
What are risks of untreated status epilepticus?
Brain damage, respiratory failure, or death.
215
What is the first-line treatment for status epilepticus?
IV Diazepam (rapid, short-acting)
Alternatives: IV Lorazepam or IM Midazolam
216
What medications are given after initial treatment to maintain seizure control?
Phenytoin (Dilantin)
Phenobarbital
217
What drugs are used if status epilepticus continues?
Midazolam
Propofol
High-dose barbiturates
218
What are important nursing actions when treating status epilepticus?
Administer IV meds slowly to avoid respiratory depression
Monitor airway, vitals, oxygenation, and cardiac rhythm
219
What is the therapeutic range for phenytoin?
10–20 mcg/mL
220
What are key seizure precautions in the hospital?
Padded bed rails
Suction equipment available
Monitor patient closely
221
What are important teaching points for patients on AEDs?
Take same time daily, with food/milk
Do not stop abruptly
Avoid alcohol and CNS depressants
Avoid driving until drug effects are known
Practice good oral hygiene (phenytoin can cause gingival hyperplasia)
Wear medical alert ID
Use backup contraception (AEDs reduce oral contraceptive effectiveness)
222
What is cyclobenzaprine primarily used to treat?
Short-term treatment of acute muscle spasms, commonly from back injuries, muscle strains, or post-op muscle tension.
223
How does cyclobenzaprine work?
Acts centrally at the brainstem to reduce tonic somatic motor activity. It has no direct effect on the neuromuscular junction.
224
In which cardiac conditions is cyclobenzaprine contraindicated?
Acute myocardial infarction, AV block or bundle branch block, cardiac arrhythmias, heart failure, QT prolongation.
225
What medications or conditions should be avoided or used cautiously with cyclobenzaprine?
MAOIs (interaction can cause serious effects), hyperthyroidism, seizure disorders, urinary retention, prostatic hypertrophy, hepatic disease, older adults (↑ risk of sedation, anticholinergic effects), breastfeeding (not recommended).
226
What are common anticholinergic side effects of cyclobenzaprine?
Dry mouth, blurred vision, urinary retention, constipation.
227
What CNS-related side effects might occur with cyclobenzaprine?
Drowsiness, dizziness, fatigue, confusion, nervousness, headache.
228
What are some serious adverse effects of cyclobenzaprine?
Angioedema (lips/tongue), myocardial infarction, seizures, paralytic ileus.
229
Why should cyclobenzaprine not be stopped abruptly?
To prevent rebound muscle spasms — taper over 1 week.
230
What substances should be avoided while taking cyclobenzaprine?
Alcohol and CNS depressants, as they intensify sedation.
231
What safety advice should be given regarding daily activities?
Avoid driving or operating machinery until you know how the drug affects you.
232
How long should cyclobenzaprine therapy typically last?
No more than 3 weeks, unless directed by a healthcare provider.
233
What symptoms should be reported to a healthcare provider?
Fainting, dizziness, vision changes, or allergic reactions.
234
How should cyclobenzaprine be taken to reduce GI upset?
With food.
235
What precautions should be taken regarding sunlight exposure?
Avoid prolonged sunlight exposure — potential photosensitivity.
236
What assessments should be done before giving cyclobenzaprine?
Cause and duration of muscle spasms, vital signs and cardiac history, drug interactions (especially with MAOIs).
237
How should effectiveness of cyclobenzaprine be evaluated?
Reduced pain and muscle spasm, and improved mobility.
238
What should nurses monitor for during therapy?
CNS changes — confusion, sedation, dizziness.
239
What type of symptoms does haloperidol treat in schizophrenia?
Positive symptoms such as delusions and hallucinations.
240
What are common anticholinergic side effects of haloperidol?
Dry mouth
Constipation
Blurred vision
Urinary retention
241
What are common CNS and systemic side effects of haloperidol?
Drowsiness, confusion
Depression, tremors
Weight changes
Headache, hyperhidrosis
Erectile dysfunction
242
What are extrapyramidal symptoms (EPS) caused by haloperidol?
Pseudoparkinsonism: pill-rolling, shuffling gait
Akathisia: restlessness, inability to sit still
Tardive dyskinesia: involuntary tongue/lip movements — must be reported immediately
243
What is Neuroleptic Malignant Syndrome (NMS) and what are its signs?
A life-threatening reaction; symptoms include sudden high fever, muscle rigidity, altered mental status, and tachycardia. Requires immediate drug discontinuation.
244
What serious blood-related and cardiovascular effects can haloperidol cause?
Seizures
Dysrhythmias
Orthostatic hypotension
Agranulocytosis, leukopenia, neutropenia
Thrombocytopenia
Hepatic failure, rhabdomyolysis
245
What are key contraindications to check before administering haloperidol?
Parkinsonism
CNS depression
Glaucoma
Dementia
Seizure disorders, liver/cardiac disease, alcohol use
246
What symptoms should nurses monitor for to detect EPS or tardive dyskinesia?
Pill-rolling, shuffling gait
Tongue protrusion, lip smacking, facial tics
Restlessness or inability to sit still
247
What should be done if a patient develops a high fever while on haloperidol?
Stop the drug immediately — it may indicate Neuroleptic Malignant Syndrome.
248
What lab tests should be monitored during haloperidol therapy?
CBC (for signs of pancytopenia or low WBCs)
Glucose levels (risk of hyper/hypoglycemia)
249
What safety advice should be given to a patient starting haloperidol?
Avoid driving or hazardous activities until effects are known
Use sunscreen and sunglasses for photosensitivity
Report sexual dysfunction or irregular menstruation
250
What are the FDA-approved uses of venlafaxine?
Major depressive disorder (MDD), Generalized anxiety disorder (GAD), Social anxiety disorder (SAD), Panic disorder
251
What are some off-label uses of venlafaxine?
PTSD, Chronic pain disorders (e.g., fibromyalgia)
252
What are common side effects of venlafaxine?
Drowsiness, dizziness, headache, Dry mouth, nausea, vomiting, Weight loss, constipation, Nervousness, insomnia, Sexual dysfunction
253
What cardiovascular side effect is dose-dependent with venlafaxine?
Hypertension — blood pressure increases at higher doses
254
What are other serious adverse effects of venlafaxine?
Tachycardia, Seizures, Hyponatremia, Serotonin syndrome, Suicidal ideation, Increased bleeding risk (especially with NSAIDs, aspirin, anticoagulants)
255
What are signs of serotonin syndrome?
Confusion, agitation, Fever, sweating, Tremors, hyperreflexia, Myoclonus (muscle jerks)
256
Why should venlafaxine not be stopped abruptly?
To prevent withdrawal symptoms such as dizziness, sensory disturbances, and anxiety — taper slowly.
257
How long does it typically take to see therapeutic effects from venlafaxine?
Several weeks
258
What symptoms should patients report immediately?
Suicidal ideation, Worsening depression or anxiety, Signs of serotonin syndrome
259
What substances should be avoided while taking venlafaxine?
Alcohol, CNS depressants, St. John’s Wort or other serotonergic agents
260
What vital sign should be monitored regularly with venlafaxine, especially at higher doses?
Blood pressure
261
What are the primary uses for opioid analgesics like morphine and fentanyl?
Moderate to severe acute or chronic pain
Pain unresponsive to non-opioids
Cancer pain, postoperative pain, trauma, myocardial infarction
Methadone is also used for opioid dependence and maintenance therapy
262
What should be assessed before and after administering opioids?
Pain type, location, and intensity
Respiratory rate (hold if <12/min)
Level of consciousness and sedation
Blood pressure and heart rate
Bowel function (due to risk of constipation)
History of substance use or fall risk
263
What is a key principle when starting opioids in opioid-naïve or elderly patients?
Start low, go slow
264
Why should opioids be given with food?
To minimize nausea
265
How should opioids be scheduled for chronic pain?
Use around-the-clock dosing with additional PRN doses for breakthrough pain
266
What interventions help manage opioid-induced constipation?
Encourage fluids and fiber
Use stool softeners or laxatives as needed
267
What safety precautions are needed if the patient experiences sedation or dizziness?
Implement fall precautions
268
Why should doses and routes of opioids be double-checked?
Because many opioids are high-alert medications and pose serious harm if misdosed
269
What are common central nervous system side effects of opioids?
Sedation
Dizziness
Euphoria
Confusion
270
What respiratory effect is most concerning with opioid use?
Respiratory depression, which is dose-dependent and potentially life-threatening
271
What GI and GU side effects are associated with opioids?
Constipation
Nausea and vomiting
Urinary retention
272
What other common side effects may occur with opioids?
Itching or rash (due to histamine release)
Tolerance, dependence, and withdrawal with long-term use
273
What is the class of naloxone?
Opioid antagonist
274
What is the mechanism of action of naloxone?
It competes with opioids at receptor sites to reverse opioid effects, especially respiratory depression.
275
What routes can naloxone be administered?
IV, IM, SubQ, Intranasal
276
What is naloxone used for?
Reversing respiratory depression from opioid overdose
## Footnote
Emergency reversal of suspected community overdoses (often intranasal)
277
Why might repeated naloxone doses be necessary?
It has a short duration of action compared to many opioids.
278
What are important nursing considerations after naloxone administration?
Monitor for return of pain or withdrawal symptoms
## Footnote
Stay with the patient — may become agitated or combative
Educate on intranasal use for take-home prescriptions
279
What is naltrexone used for?
Long-term relapse prevention in opioid or alcohol use disorder
280
How does naltrexone work?
It blocks the euphoric effects of opioids and alcohol.
281
Is naltrexone used in acute overdose situations?
No — it's used after detoxification for maintenance, not for emergency reversal.
282
What are the routes of administration for naltrexone?
PO and IM extended-release
283
What is a trough level?
The lowest concentration of a drug in the bloodstream, measured immediately before the next dose.
284
What is a peak level?
The highest concentration of a drug in the bloodstream, usually measured 30 min to 1 hour after IV infusion ends.
285
Why are peak and trough levels monitored?
To avoid toxicity (e.g., ototoxicity, nephrotoxicity)
## Footnote
Ensure the drug remains in the therapeutic range
Guide dose adjustments, especially with renal impairment
286
What are the peak and trough levels for vancomycin?
Trough: 5–20 mcg/mL
## Footnote
Peak: 20–40 mcg/mL
287
What are key nursing actions if a patient has signs of vancomycin toxicity (e.g., Red Man Syndrome)?
Slow the infusion rate as ordered and monitor for renal function
288
What are the peak and trough levels for gentamicin?
Trough: <1–2 mcg/mL
## Footnote
Peak: 5–8 mcg/mL
289
What adverse effects should be monitored with gentamicin?
Ototoxicity (e.g., tinnitus, hearing loss)
## Footnote
Nephrotoxicity (e.g., ↓ urine output, ↑ creatinine)
290
When should drug levels be drawn?
Suspected toxicity
## Footnote
Renal impairment
Long-term or high-dose IV therapy
Drugs with a narrow therapeutic window
During initial dose titration or therapy changes
291
Why is chemotherapy often given in cycles?
To maximize cancer cell destruction while allowing normal cells to recover.
292
What therapies may be combined with chemotherapy for cancer treatment?
Radiation, Surgery, Hormone therapy, Immunotherapy.
293
What types of chemotherapy agents are used in combination therapy?
CCNS (cell-cycle nonspecific) agents like Cyclophosphamide, CCS (cell-cycle specific) agents like Vincristine.
294
What normal cells are most affected by chemotherapy?
Rapidly dividing cells in the skin, hair, GI tract, mucous membranes, bone marrow, and reproductive system.
295
What should patients know about chemotherapy-induced hair loss (alopecia)?
It's common but temporary — they can prepare with wigs or hats.
296
How can mucositis (mouth sores) be managed during chemo?
Use baking soda/salt rinses, avoid alcohol-based mouthwashes, use soft toothbrush, saliva substitutes, ice chips.
297
What strategies help manage GI effects like nausea and anorexia during chemo?
Give antiemetics, encourage high-calorie, high-protein, small frequent meals.
298
What should be discussed with patients regarding chemotherapy and fertility?
Infertility may be temporary or permanent, counsel about fertility preservation before starting therapy.
299
What are symptoms of anemia from myelosuppression?
Fatigue, shortness of breath, pallor, dizziness.
300
How can patients manage anemia at home?
Plan rest periods, elevate the HOB, use oxygen as prescribed.
301
What treatments may be used for chemotherapy-induced anemia?
Iron supplements, blood transfusions, Epoetin alfa.
302
What are signs of neutropenia?
Fever, sore throat, chills.
303
What infection prevention teaching should be provided for neutropenic patients?
Perform hand hygiene, avoid crowds and infections, report temperature ≥ 101°F (38.3°C).
304
What medication may be prescribed to stimulate WBC production?
Filgrastim.
305
What are signs of thrombocytopenia?
Bruising, petechiae, bleeding gums, hematuria, black stools.
306
What precautions should thrombocytopenic patients take?
Use a soft toothbrush, electric razor, avoid NSAIDs, IM injections, and invasive procedures, monitor for occult bleeding (e.g., in stool or urine).
307
What types of cancer is cyclophosphamide commonly used to treat?
Breast cancer, leukemia, Hodgkin’s disease, ovarian cancer
308
What is the mechanism of action of cyclophosphamide?
It is cell cycle nonspecific and alkylates DNA, interfering with DNA replication.
309
What is a serious urinary complication of cyclophosphamide?
Hemorrhagic cystitis (bleeding bladder)
310
What are other common side effects of cyclophosphamide?
Nausea, vomiting, anorexia, stomatitis, myelosuppression, alopecia, photosensitivity and skin reactions, reproductive toxicity (amenorrhea, infertility)
311
Why is hydration important with cyclophosphamide therapy?
To prevent hemorrhagic cystitis — patients should drink ≥2 L/day and void every 2–3 hours.
312
When should cyclophosphamide be taken to minimize bladder toxicity?
Early in the day to avoid drug accumulation in the bladder overnight.
313
How should nausea from cyclophosphamide be managed?
Pre-medicate with antiemetics 30–60 minutes before the infusion.
314
What should be monitored at the IV site when administering cyclophosphamide?
Check for extravasation, as it is a vesicant and can cause necrosis.
315
What safety measures should nurses take when handling cyclophosphamide?
Wear gloves, wash hands thoroughly after handling.
316
What labs should be monitored during cyclophosphamide therapy?
CBC, BUN & creatinine, LFTs, electrolytes
317
What infection and bleeding precautions should be taught to patients?
Avoid crowds, wash hands, report fever; use soft toothbrush, avoid NSAIDs or injury.
318
Why should live vaccines be avoided?
Because immunosuppression increases the risk of infection from live vaccines.
319
What skin care teaching should be provided?
Use sunblock (SPF ≥50) and protective clothing due to photosensitivity.
320
What dietary advice should be given for patients taking cyclophosphamide?
Eat a low-purine diet (avoid organ meats, beans); avoid citric acid — helps reduce bladder irritation and alkalize urine.
321
What are the indications for montelukast?
Asthma (prophylaxis and chronic treatment), allergic rhinitis, exercise-induced bronchospasm
322
What are the therapeutic effects of montelukast?
Reduces inflammation, bronchoconstriction, and mucus production. Improves lung function and nighttime asthma symptoms.
323
Can montelukast be used for acute asthma attacks?
No — it is not a rescue medication
324
When should montelukast be taken?
Daily in the evening, even if symptoms are not present
325
What serious symptoms should be reported while on montelukast?
Neuropsychiatric symptoms: agitation, depression, suicidal thoughts
326
How long does it take for montelukast to reach full effectiveness?
Up to 1 week
327
What is the correct order for using multiple inhalers?
Bronchodilator (e.g., Albuterol) — opens the airway. Wait 5 minutes. Corticosteroid (e.g., Beclomethasone) — reduces inflammation.
328
Why is a bronchodilator used before a corticosteroid?
To open airways and allow better absorption of the corticosteroid
329
What should be done to prevent oral thrush after corticosteroid inhalation?
Rinse the mouth thoroughly after use
330
What inhaler device can help deliver corticosteroids more effectively to the lungs?
A spacer
331
What are the key steps for correct inhaler technique?
Shake the inhaler. Exhale fully. Press the inhaler while inhaling deeply. Hold breath for ~10 seconds.
332
How long should a patient wait between inhalers if using more than one?
5 minutes
333
What are the indications for albuterol?
Acute asthma attacks, Exercise-induced bronchospasm, Bronchospasm from reactive airway disease
334
What is the standard dosing for albuterol via metered-dose inhaler (MDI)?
1–2 puffs every 4–6 hours as needed
335
When is a nebulizer preferred for albuterol administration?
In moderate to severe cases or for patients unable to use an MDI
336
What patient teaching should be provided about albuterol use?
Use before exercise if prescribed for prevention, Learn proper inhaler technique and spacer use, Do not overuse — may cause tolerance, tremors, or tachycardia, Report palpitations, chest pain, or jitteriness
337
What is beclomethasone used for?
Maintenance therapy for chronic asthma, Often combined with long-acting beta-agonists in moderate/severe asthma, Not used for acute attacks
338
What is the typical dosing frequency for beclomethasone?
Usually 1–2 puffs twice daily
339
What is the correct sequence when using albuterol and beclomethasone?
Use albuterol first to open airways, Wait 5 minutes, Then use beclomethasone
340
Why should patients rinse their mouth after using beclomethasone?
To prevent oral candidiasis (thrush)
341
How soon can therapeutic effects be expected with beclomethasone?
1–2 weeks of consistent use
342
What should patients know about discontinuing long-term corticosteroids like beclomethasone?
Do not stop abruptly — taper if discontinuing under provider guidance
343
What side effects should patients monitor while using beclomethasone?
Hoarseness, Dry mouth — encourage hydration
344
What are the primary uses of digoxin?
Heart failure, Atrial fibrillation/flutter, Paroxysmal atrial tachycardia
345
What are the routes of administration for digoxin?
PO, IM, and IV
346
What GI side effects are common with digoxin?
Anorexia, nausea, vomiting, diarrhea, abdominal pain
347
What CNS side effects can occur with digoxin?
Headache, Blurred or yellow vision, Dizziness, Confusion, Visual impairment, Anxiety
348
What cardiac side effects may be life-threatening with digoxin?
Bradycardia and dysrhythmias
349
What rare hematologic side effect may occur?
Thrombocytopenia
350
What are early signs of digitalis toxicity?
Nausea, Vomiting, Diarrhea, Visual disturbances (e.g., yellow/green halos), Bradycardia, Dysrhythmias
351
What should be done before administering digoxin?
Take apical pulse for 1 full minute — hold if <60 bpm
352
What is the therapeutic range for serum digoxin levels?
0.8–2 ng/mL
353
What electrolyte imbalances increase the risk of digoxin toxicity?
Hypokalemia, Hypomagnesemia, Hypercalcemia
354
What signs of heart failure should be monitored when a patient is on digoxin?
Peripheral and pulmonary edema
355
What should patients know about taking digoxin doses?
Take exactly as prescribed; do not skip or double doses
356
What should patients be taught to do daily before taking digoxin?
Check their pulse rate
357
What symptoms of toxicity should patients report?
Low pulse, Nausea/vomiting, Vision changes, Dizziness
358
What should patients avoid when taking digoxin?
OTC drugs and herbal supplements unless approved by the provider
359
What dietary recommendation is important for patients on digoxin and diuretics?
Eat potassium-rich foods (e.g., fruits, juices, vegetables)
360
How should digoxin be stored?
In childproof bottles, away from children
361
What are the main indications for nitroglycerin?
Angina, Acute myocardial infarction (MI), Hypertensive crisis, Heart failure
362
What is the mechanism of action of nitroglycerin?
It reduces myocardial oxygen demand by dilating veins and decreasing preload and afterload.
363
What routes can nitroglycerin be administered through?
Sublingual (SL), Oral extended-release (PO ER), Ointment, Transdermal patch, IV
364
What are common side effects of nitroglycerin?
Hypotension, Tachycardia, Headache, Dizziness, Blurred vision, Syncope, Flushing, dry mouth, nausea, weakness
365
What serious adverse reactions can occur with nitroglycerin?
Orthostatic hypotension, Bradycardia, palpitations, Rare: Myocardial infarction, methemoglobinemia
366
What vital sign must be checked before giving nitroglycerin?
Blood pressure — hold dose if SBP < 90 mmHg
367
What position should the patient be in when receiving SL nitroglycerin?
Sitting or lying down to prevent falls from hypotension
368
What helps absorption of SL nitroglycerin?
Offer sips of water before administration
369
What is the dosing protocol for SL nitroglycerin during chest pain?
1 tablet every 5 minutes, up to 3 doses total. If no relief after 1 dose, call 911
370
What are important application rules for nitroglycerin ointment or patches?
Wear gloves or use an applicator, Rotate sites and apply to clean, hairless skin, Remove patch at night (8–12 hrs) to prevent tolerance, Do not apply near defibrillator pads (explosion risk)
371
How should SL nitroglycerin tablets be stored?
In the original amber bottle, away from light and moisture
372
What should a patient do if chest pain persists after the first nitroglycerin dose?
Call 911 immediately
373
What drug class should be avoided with nitroglycerin and why?
PDE-5 inhibitors (e.g., Viagra, Cialis) — can cause severe hypotension
374
What medication can be used to relieve nitroglycerin-induced headaches?
Acetaminophen
375
Why should nitroglycerin and related meds not be stopped abruptly?
Risk of rebound angina or hypertensive crisis
376
What safety teaching should be reinforced to prevent orthostatic hypotension?
Rise slowly from sitting or lying positions
377
What are beta blockers used to treat?
Hypertension, Angina, Heart failure, Acute MI, Dysrhythmias
378
Why should beta blockers not be stopped abruptly?
Risk of rebound hypertension, angina, or myocardial infarction
379
What home monitoring should patients do while on beta blockers?
Check radial pulse and blood pressure daily. Report pulse <60 bpm or significantly low BP.
380
What symptoms should patients report while on beta blockers?
Dizziness, Lightheadedness, Fatigue, Cold extremities, Sexual dysfunction
381
What is a major difference between cardioselective and non-selective beta blockers?
Cardioselective (e.g., Metoprolol): Block beta-1 → ↓ HR, minimal lung effects. Non-selective (e.g., Propranolol): Block beta-1 & beta-2 → can cause bronchospasm and mask hypoglycemia.
382
Who should not take non-selective beta blockers?
Patients with COPD, asthma, or diabetes
383
What are common side effects of beta blockers?
Bradycardia, Dizziness, postural hypotension, Fatigue, headache, nausea, Depression, erectile dysfunction, peripheral edema
384
What serious adverse effects can occur with beta blockers?
Heart failure, AV block, Dysrhythmias, Agranulocytosis, thrombocytopenia
385
What conditions are ACE inhibitors used to treat?
Hypertension, Heart failure, Post-MI (to prevent ventricular remodeling), Diabetic nephropathy
386
How do ACE inhibitors work?
They block conversion of angiotensin I to angiotensin II, causing vasodilation and decreased aldosterone, leading to reduced BP, preload, and afterload.
387
What is a common side effect of ACE inhibitors due to bradykinin buildup?
A dry, persistent cough
388
What lab value should be closely monitored with ACE inhibitor use?
Potassium — risk of hyperkalemia
389
What are other common side effects of ACE inhibitors?
Dizziness, headache, fatigue, Nausea, vomiting, Hypotension, insomnia
390
What is a life-threatening adverse effect of ACE inhibitors?
Angioedema — facial/lip/throat swelling requiring emergency treatment
391
What serious hematologic and renal effects may occur with ACE inhibitors?
Agranulocytosis, neutropenia (check CBC), Renal impairment
392
What patient teaching should be emphasized with ACE inhibitors?
Report dry cough, may require switching to ARB. Avoid potassium-rich foods and salt substitutes. Rise slowly to prevent orthostatic hypotension. Report signs of facial swelling or sore throat. Do not take OTC cold meds without provider approval. Contraindicated in pregnancy.
393
What routes can heparin be administered?
Subcutaneous and IV
394
What are the clinical uses for heparin?
Pulmonary embolism (PE), Myocardial infarction (MI), Deep vein thrombosis (DVT), Unstable angina, Prosthetic heart valves, Percutaneous coronary intervention (PCI)
395
What common medications and supplements increase bleeding risk with heparin?
Aspirin, NSAIDs, other anticoagulants, Herbals: ginkgo, garlic, ginseng
396
What lab values should be monitored during heparin therapy?
aPTT (activated partial thromboplastin time): therapeutic = 30–85 seconds, Platelet count — monitor for HIT (Heparin-Induced Thrombocytopenia)
397
What are signs of bleeding to monitor for on heparin?
Petechiae, Hematuria, Melena (black stools)
398
What is the antidote for heparin overdose or uncontrolled bleeding?
Protamine sulfate
399
What is warfarin used for?
PE, DVT, Atrial fibrillation, MI, Prosthetic heart valves
400
How does warfarin work?
Inhibits vitamin K-dependent clotting factors II, VII, IX, and X
401
What is significant about warfarin’s pharmacokinetics?
Highly protein bound, Long half-life, Slow onset and long duration
402
What lab tests are used to monitor warfarin therapy?
INR: Normal: 0.8–1.2, Therapeutic: 2–3 (up to 3.5 for prosthetic valves), PT: 1.25–2.5× control (Normal = 11–15 sec)
403
What increases bleeding risk while taking warfarin?
Aspirin, NSAIDs, sulfonamides, many herbals, Smoking (increases metabolism, may need higher dose), Displacement from protein-binding sites
404
What is the antidote for warfarin overdose or INR >4?
Vitamin K1 (phytonadione): IV 5–10 mg, Fresh frozen plasma if Vitamin K is ineffective
405
What dietary precautions should be taught to patients on warfarin?
Avoid green leafy vegetables (high in vitamin K: broccoli, legumes), Maintain a consistent intake if not avoiding completely
406
What general safety teaching should be given to patients on warfarin?
Use soft toothbrush and electric razor, Report bleeding in gums, stool, or urine, Wear a MedicAlert bracelet, Attend regular INR checks, Avoid OTC/herbal meds unless approved, Do not take aspirin unless prescribed
407
What is the route of administration for alteplase?
IV (intravenous)
408
What conditions is alteplase used to treat?
Myocardial infarction (MI) — within 12 hours of symptom onset
Ischemic stroke — within 3–4.5 hours of symptom onset
Pulmonary embolism (PE)
Occluded IV catheters
409
What is the mechanism of action of alteplase?
Converts plasminogen to plasmin, which dissolves fibrin clots
410
What vital signs and assessments should be continuously monitored with alteplase therapy?
Vital signs
Signs of bleeding: ↓ BP, ↑ HR, hematuria, hematemesis, rectal bleeding
ECG — monitor for reperfusion dysrhythmias
411
What procedures should be avoided during alteplase administration?
Arterial punctures
IM injections — due to high bleeding risk
412
What is the monitoring schedule during alteplase administration?
Every 15 min for the first hour
Then every 30 min for 8 hours
Then hourly for 24 hours
413
What medication is used to reverse the effects of alteplase in case of bleeding?
Aminocaproic acid — an antifibrinolytic agent
414
What part of the brain is responsible for initiating the vomiting reflex?
The Chemoreceptor Trigger Zone (CTZ)
415
What stimulates the CTZ to trigger vomiting?
Drugs, Toxins, Vestibular center signals
416
What happens when the vestibular center is disrupted?
It can cause motion sickness, nausea, and vomiting
417
What are common causes of vomiting?
GI infections, food poisoning, Motion sickness, pregnancy, Medications, GERD, peptic ulcers, Migraines, gallbladder disease, Appendicitis, bowel obstruction
418
What OTC antihistamines are used for nausea and motion sickness?
Dimenhydrinate, Cyclizine, Meclizine, Diphenhydramine
419
How do OTC antihistamine antiemetics work?
They inhibit vestibular stimulation in the middle ear
420
What are common side effects of OTC antihistamine antiemetics?
Drowsiness, Dry mouth, Constipation
421
How does bismuth subsalicylate work?
It acts directly on the gastric mucosa to reduce nausea
422
What are common side effects of bismuth subsalicylate?
Black tongue or stool, Gastric discomfort, tinnitus, Nausea
423
What warning should be given to patients on aspirin taking Pepto-Bismol?
Stop if tinnitus occurs — may indicate salicylate toxicity
424
What are two common prescription antihistamine/anticholinergic antiemetics?
Hydroxyzine and Scopolamine
425
What is a key contraindication for anticholinergic antiemetics?
Glaucoma
426
What are side effects of prescription antihistamine/anticholinergic antiemetics?
Drowsiness, dizziness, Dry mouth, Constipation, Urinary retention
427
What benzodiazepine is used for chemo-induced nausea?
Lorazepam
428
What is the mechanism of ondansetron (Zofran)?
It's a 5-HT3 serotonin receptor antagonist
429
What is a common phenothiazine antiemetic and its classification?
Promethazine (Phenergan) – a high-alert drug
430
What cannabinoid antiemetic is used for chemotherapy nausea?
Dronabinol (Marinol)
431
What are side effects of dronabinol?
Euphoria, mood swings, depression, Orthostatic hypotension
432
What is metoclopramide used for and how is it given?
Used for nausea and vomiting
## Footnote
Given PO, IM, IV, or intranasal
433
What are side effects of metoclopramide?
Drowsiness, dizziness, Dysgeusia (altered taste), Restlessness, nausea, vomiting
434
What is GERD?
Inflammation of the esophageal mucosa caused by the reflux of gastric acid due to an incompetent lower esophageal sphincter.
435
What factors aggravate or increase risk of GERD?
Smoking (accelerates disease)
NSAID use (e.g., ibuprofen)
Lying down after eating
436
What nonpharmacologic lifestyle changes help manage GERD?
Weight loss if overweight
Elevate head of bed while sleeping
Avoid eating before bedtime
Quit smoking
437
What dietary triggers should be avoided in GERD?
Caffeine, alcohol
Spicy foods, chocolate
Tomatoes, carbonated drinks
438
What is PUD?
An ulcer or erosion in the esophagus, stomach, or duodenum (upper GI tract)
439
What is the normal pH of gastric secretions?
Between 2 to 5
440
What protects the stomach lining from acid in the GI tract?
The gastric mucosal barrier (GMB)
441
What are components of the gastric mucosal barrier (GMB)?
Mucus cells
Tight junctions
Bicarbonate secretion
Adequate blood flow
442
What are common causes of peptic ulcers?
H. pylori infection
NSAID use
Excess acid secretion
Stress
443
What is triple therapy for H. pylori eradication?
Metronidazole
Amoxicillin
PPI (e.g., Omeprazole or Lansoprazole)
+/- Clarithromycin
444
What other agents may be included in H. pylori therapy regimens?
Tetracycline
Bismuth subsalicylate
445
How long does H. pylori therapy typically last?
7–14 days
446
Why are multiple antibiotics used for H. pylori treatment?
To prevent antibiotic resistance
447
Why are tranquilizers and anticholinergics no longer commonly used for ulcer treatment?
Due to side effects and the availability of more effective drugs
448
What is the class of levothyroxine?
Thyroid hormone replacement therapy
449
What are the main indications for levothyroxine?
Primary hypothyroidism (e.g., Hashimoto’s thyroiditis), Simple goiter, Chronic lymphocytic thyroiditis, Thyroid cancer (as a suppressant)
450
What is the route of administration for levothyroxine?
PO and IV
451
How does levothyroxine work in the body?
Increases metabolic rate, oxygen use, and glucose utilization; Stimulates protein synthesis; Promotes growth, cardiac output, and renal blood flow; Mimics endogenous T4, which converts to T3 in tissues
452
What symptoms may indicate levothyroxine overdose (hyperthyroidism-like effects)?
Tachycardia, palpitations, chest pain; Nervousness, tremors, insomnia, irritability; Weight loss, diaphoresis, heat intolerance, flushing; GI upset: nausea, vomiting, cramps; Amenorrhea, anorexia, headache
453
What are serious adverse reactions associated with levothyroxine?
Thyroid crisis/storm; Cardiac dysrhythmias (e.g., atrial fibrillation); Angina, cardiovascular collapse; Seizures, osteoporosis, rash, alopecia
454
When should levothyroxine be taken?
On an empty stomach; Before breakfast; With a full glass of water
455
Is levothyroxine a short-term or long-term therapy?
Lifelong therapy — do not stop abruptly
456
What labs should be monitored regularly during levothyroxine therapy?
TSH, T3, and T4
457
What are signs of overdose that patients should report?
Chest pain, tachycardia; Heat intolerance, restlessness, tremors
458
What dietary restrictions should be taught to patients taking levothyroxine?
Avoid: Soy; Cruciferous vegetables (broccoli, cabbage); Iodized salt, shellfish; Coffee
459
Why should patients wear a MedicAlert bracelet when on levothyroxine?
To inform emergency providers of thyroid hormone dependence
460
What are signs that levothyroxine therapy is working?
Increased energy; Improved mood and cognition; Decreased constipation; Normalized weight
461
What are common causes of hyperglycemia in diabetic patients?
Inadequate or missed insulin dose
Illness, infection, stress (cortisol release)
Steroid or thiazide diuretic use
Overeating, especially high-carb diet
Lack of exercise
462
What are the classic “3 P” symptoms of hyperglycemia?
Polyuria (frequent urination)
Polydipsia (increased thirst)
Polyphagia (increased hunger)
463
What are additional symptoms of hyperglycemia?
Dry skin
Blurred vision
Fatigue
Slow wound healing
Recurrent infections
464
What are common causes of hypoglycemia?
Too much insulin or oral antidiabetics
Delayed or missed meals, low carb intake
Strenuous exercise
Alcohol use
Drug interactions (e.g., MAOIs, beta blockers)
465
What are early symptoms of hypoglycemia?
Cold, clammy skin
Sweating, tremors, confusion
Slurred speech, headache, tachycardia
466
What are severe symptoms of hypoglycemia?
Seizures
Loss of consciousness
467
What type of insulin is used IV or SubQ for diabetic ketoacidosis (DKA)?
Regular insulin (short-acting)
468
What is the onset, peak, and duration of regular insulin?
Onset: 30–60 min
Peak: 1.5–3.5 hours
Duration: 5–8 hours
469
When should rapid-acting insulin (e.g., Lispro, Aspart) be administered?
Within 5–15 minutes before meals
470
Can rapid-acting insulin be given IV?
No — it is SubQ only
471
What are oral treatments for mild hypoglycemia?
Glucose tablets
Juice
Sugar-containing candy or drinks
472
What medications are used if a hypoglycemic patient is unconscious?
Glucagon (IM, SubQ, or IV)
Dextrose 50% (D50W) — IV in hospital/emergency settings
473
What education should be given regarding blood glucose monitoring?
How and when to check blood glucose
Recognize symptoms of both hyper- and hypoglycemia
474
Why should patients rotate insulin injection sites?
To prevent lipodystrophy (lumpy or scarred skin)
475
What precaution is necessary when a patient on Metformin is receiving IV contrast?
Hold metformin 48 hours before and after contrast use to avoid lactic acidosis
476
When is hypoglycemia most likely to occur with insulin therapy?
During the peak action time of the insulin
477
Why is wearing a MedicAlert bracelet important for diabetic patients?
To alert others in emergencies that the patient has diabetes and may need urgent glucose or insulin support
478
What hormones do combined hormonal contraceptives (CHCs) contain?
Estrogen and progestin
479
What are the mechanisms by which CHCs prevent pregnancy?
Suppress ovulation
Thicken cervical mucus
Thin the endometrial lining
480
What acronym is used to guide informed consent for CHC use?
BRAIDED
## Footnote
Benefits, Risks, Alternatives, Inquiries, Decision, Explanation, Documentation
481
What acronym helps patients remember warning signs of serious CHC side effects?
ACHES
## Footnote
Abdominal pain, Chest pain, Headache, Eye problems, Severe leg pain
482
When should CHCs be started postpartum if the patient is not breastfeeding?
4–6 weeks postpartum
483
Why should patients avoid smoking while on CHCs?
It significantly increases the risk of cardiovascular events (e.g., stroke, MI)
484
What should patients do if they are taking medications like St. John’s Wort with CHCs?
Use backup contraception — St. John’s Wort may decrease contraceptive effectiveness
485
Do CHCs provide protection against sexually transmitted infections (STIs)?
No — they do not protect against STIs
486
What is a helpful strategy for reducing nausea when taking CHCs?
Take with food
487
What are the 6 rights of drug administration?
Right patient, drug, dose, route, time, and documentation
488
How do liver and renal function in pediatric patients differ from adults?
Hepatic enzymes and renal excretion are reduced in pediatric patients
489
Name 3 common side effects of adrenergic drugs.
Tachycardia, palpitations, restlessness
## Footnote
Also: tremors, hypertension, urine retention
490
What are common side effects of anticholinergic medications?
Blurred vision, urine retention, dry mouth, constipation
491
What pharmacokinetic processes are influenced by physiologic aging?
Absorption, distribution, metabolism, and excretion
492
What can cause rebound hypertension?
Abruptly discontinuing antihypertensive medication
493
What lab test and antidote are used for heparin?
PTT or aPTT; antidote: protamine sulfate
494
What lab test and antidote are used for warfarin?
INR; antidote: Vitamin K
495
What should a nurse do before giving digoxin?
Take apical pulse
496
Name 3 side effects or adverse effects of ACE inhibitors.
Persistent dry cough, hypotension, hyperkalemia
## Footnote
Also: dizziness, angioedema
497
What is given to women with heavy menstrual periods to relieve anemia?
Ferrous sulfate (iron supplements)
498
What medication is used to augment labor and treat uterine atony?
Oxytocin
499
What is a common occurrence at the start of combined hormonal therapy?
Breakthrough bleeding (BTB)
500
What medication is used to treat hypogonadism?
Testosterone
501
What drug used for infertility may cause breast tenderness, increased appetite, anxiety, and flushing?
Clomiphene citrate
502
What is the correct order for administering inhaled respiratory medications?
Short-acting bronchodilator → long-acting bronchodilator → inhaled glucocorticoid
503
What results from frequent use of nasal decongestants?
Rebound nasal congestion
504
Name a bronchodilator with a narrow therapeutic index of 5–15 mcg/mL.
Theophylline or aminophylline
505
Name 3 side effects of tiotropium.
Dry mouth, blurred vision, insomnia
## Footnote
Also: urinary retention, constipation
506
What drug treats asthma and exercise-induced bronchospasm by binding leukotriene receptors?
Montelukast
507
What medication is combined with levodopa to increase CNS availability in Parkinson’s treatment?
Carbidopa
508
What benzodiazepine is given IV for status epilepticus?
Diazepam or lorazepam
509
Patients taking what ADHD drug should avoid caffeine and take it in the morning?
Methylphenidate
510
Symptoms like shuffling gait, tremors at rest, and mask-like face are signs of what?
Extrapyramidal syndrome (EPS) or pseudoparkinsonism
511
What syndrome can result from SSRIs/SNRIs and causes hyperreflexia and hyperthermia?
Serotonin syndrome
512
Where should medication patches NOT be placed?
Areas with hair, bony prominences, or near medical devices
513
What drug causes nausea and vomiting if alcohol is consumed?
Disulfiram
514
What drug class increases bleeding risk when taken with heparin?
NSAIDs
515
“The patient’s legs will be warm and pink” is an example of which CJMM step?
Generate Solutions
516
What drug is given to stop bleeding from alteplase use?
Aminocaproic acid
517
What salicylate inhibits prostaglandins and has antipyretic, antiplatelet, anti-inflammatory, and analgesic effects?
Aspirin
518
Cyclobenzaprine increases the patient’s risk for what?
Falls due to dizziness and drowsiness
519
What non-opioid analgesic is safe for head injuries due to no increased bleeding risk?
Acetaminophen
520
What opioid antagonist reverses respiratory and CNS depression?
Naloxone
521
Celecoxib, a COX-2 inhibitor, is used to treat what conditions?
Osteoarthritis and rheumatoid arthritis
522
What is thyroid crisis, and what may trigger it?
A life-threatening condition triggered by changes in levothyroxine dose/brand; symptoms include tachycardia, confusion, hypotension
523
Prednisone suppresses what bodily response?
The inflammatory response
524
What condition and type of diabetes does glipizide treat?
Hyperglycemia in Type 2 Diabetes Mellitus
525
At what angle is insulin administered subcutaneously?
45–90 degrees depending on subcutaneous fat
526
What hormone stimulates glycogenolysis in the liver?
Glucagon
527
What toxicities must be monitored with gentamicin?
Ototoxicity and nephrotoxicity
528
What class of antibiotics should be avoided in penicillin-allergic patients?
Cephalosporins
529
What is a first-line antimycobacterial drug used to treat TB?
Isoniazid (also: rifampin, pyrazinamide, ethambutol)
530
What antiparasitic drug treats intestinal nematodes?
Ivermectin
531
What lab test is monitored in HIV patients on antiretrovirals?
CD4+ count
532
Name 3 infection prevention methods for immunocompromised patients.
Handwashing, avoid crowds/sick people, aseptic technique, wash produce
533
What antitumor antibiotic causes red or pink urine?
Doxorubicin or daunorubicin
534
What are signs of neurotoxicity from vincristine?
Numbness, tingling, sensory loss, ataxia, wrist/foot drop
535
What is an angiogenesis inhibitor used for in cancer treatment?
Prevents formation of new blood vessels for tumor growth
536
What medication stimulates RBC production after chemotherapy?
Erythropoietin
537
What are the fat-soluble vitamins that can become toxic with excess?
Vitamins A, D, E, and K
538
Name 3 non-pharmacological methods to reduce nausea/vomiting.
Flat soda, dry toast, weak tea, electrolyte drinks, gelatin
539
What drug class treats GERD, H. pylori, and Zollinger-Ellison syndrome?
Proton pump inhibitors (PPIs)
540
What bacteria causes peptic ulcers and is treated with triple therapy?
Helicobacter pylori
541
What opium antidiarrheal causes CNS/respiratory depression with alcohol?
Diphenoxylate with atropine
542
What type of insulin can be given IV?
Regular insulin
543
What reaction can ACE inhibitors cause, leading to facial swelling?
Angioedema
544
What are high-alert drugs that require careful administration?
Insulin, IV potassium chloride, opioids
545
What 5 parts are required on a PRN order?
Drug, dose, route, frequency, and reason
546
What is Stevens-Johnson Syndrome or TEN?
A severe skin/mucous membrane disorder triggered by medications
547
What anti-tubercular drug can turn urine, sweat, and tears orange?
Rifampin
548
What vitamin is fat-soluble, can cause night blindness if deficient, and is stored in the liver?
Vitamin A
549
Which vitamin is water-soluble, needed for collagen formation, and may cause kidney stones in excess?
Vitamin C
550
What mineral is used for RBC development and anemia, but may cause constipation?
Ferrous sulfate
551
What are the characteristics of water-soluble vitamins?
Not stored by the body, excreted in urine, not usually toxic
552
What are the characteristics of fat-soluble vitamins?
Stored in fatty tissue/liver/muscle, metabolized slowly, can be toxic in excess
553
What vitamin promotes phosphorus and calcium balance and prevents rickets?
Vitamin D
554
Which vitamin group is commonly used in patients with alcoholism?
Vitamin B complex
555
What vitamin is needed for prothrombin synthesis and is the antidote to warfarin?
Vitamin K
556
What are common side effects of Psyllium?
Cramping, flatulence, electrolyte imbalance; bowel obstruction if not enough fluid
557
What side effects are associated with epinephrine?
Tachycardia, vasoconstriction, hyperglycemia, ↓ GI motility
558
What are the side effects of lisinopril?
Cough, dizziness, hypotension, angioedema
559
What side effect can ranitidine cause?
Vitamin B12 deficiency, reversible erectile dysfunction
560
What are side effects of venlafaxine (SNRI)?
Tremors, serotonin syndrome, ED, confusion, tachycardia
561
What are side effects of cyclobenzaprine?
Drowsiness, confusion, dry mouth, blurred vision
562
What are side effects of fentanyl?
Respiratory depression, constipation, ↓ LOC
563
What side effects are associated with atenolol?
Bradycardia, hypotension, rebound hypertension if stopped abruptly
564
What toxicity risks are linked to gentamicin?
Rash, tinnitus, nephrotoxicity
565
What are side effects of methylphenidate?
Insomnia, restlessness, tremors, weight loss
566
What are side effects of haloperidol?
Neuroleptic malignant syndrome, dry mouth, weight gain
567
What teaching is needed for promethazine?
Avoid alcohol/CNS depressants; contraindicated in glaucoma
568
What should be monitored with gentamicin?
Drug levels to prevent ototoxicity, nephrotoxicity, hepatotoxicity
569
What patient teaching is important for aluminum hydroxide?
Take 1–3 hrs after meals; may cause constipation
570
What precautions are necessary with cyclophosphamide?
Avoid purines/fruits; monitor for infection/bleeding
571
What should be monitored with magnesium hydroxide?
Renal labs (BUN, Cr, Mg); may cause diarrhea
572
What is important teaching for warfarin?
Delayed onset; monitor INR; bleeding risk early on
573
What teaching is needed for nitroglycerin patches?
Apply to hairless area; 10–12 hr patch-free period; avoid hypotension
574
What should be reported when on digoxin?
HR <60, nausea, vision changes—signs of toxicity
575
What are common side effects of progestin contraceptives?
Weight gain, depression, ↓ libido; bleeding early in use
576
What should be done after administering alteplase?
Monitor for bleeding for 24 hrs; give aminocaproic acid if needed
577
Trough levels are drawn 30 minutes after antibiotics are given.
False
578
Inhaled glucocorticoids are not effective for severe asthma attacks.
True
579
Elevated levothyroxine levels can cause hyperthyroid symptoms.
True
580
NPH insulin can be given IV.
False
581
What increases the effect of methylphenidate?
Caffeine (↑ tachycardia, BP)
582
What enhances CNS depression from diphenoxylate/atropine?
Alcohol, sedatives
583
What reduces absorption of digoxin or ampicillin?
Esomeprazole
584
What drugs increase bleeding when used with heparin?
NSAIDs, aspirin, thrombolytics
585
What is montelukast used for?
Allergic rhinitis, asthma, EIB prophylaxis; lasts 24h
586
What does beclomethasone treat and how fast does it work?
Moderate-severe asthma; onset: 1–4 weeks
587
What does glucagon do and how fast?
Raises glucose via glycogenolysis; onset: ~10 min
588
What is albuterol’s onset and mechanism?
Bronchodilation; onset 5–15 min
589
What is the onset of regular insulin subcut vs. IV?
Subcut: 30 min; IV: 15 min
590
Name 3 non-drug ways to manage GERD.
Small frequent meals, no smoking, elevate HOB
591
What should be avoided to prevent GERD symptoms?
NSAIDs, restrictive clothing, eating before bed, alcohol
592
True or False: Infants have reduced GI surface area affecting absorption.
True
593
Why do infants have increased risk for drug toxicity?
Fewer protein receptor sites → more unbound drug
594
When are adult levels of liver enzymes reached in kids?
By age 11
595
What is the GFR of neonates compared to adults?
About 30% of adult GFR
596
Which is FALSE about older adult pharmacokinetics?
CNS side effect risk is reduced due to increased dopamine/cholinergic receptors → FALSE
597
What are the fat soluble vitamins?
A, D, E, K
598
How are fat soluble vitamins metabolized and excreted?
Metabolized and excreted in urine slowly
599
Where are fat soluble vitamins stored in the body?
Stored in fatty tissue, liver, and muscle
600
What can happen if fat soluble vitamins are consumed in excess?
Can be toxic – A and D
601
Which vitamin is commonly deficient in individuals?
Vitamin D
602
What are the water soluble vitamins?
B – complex and Vitamin C
603
How are water soluble vitamins metabolized?
Metabolized in various tissues throughout the body, including the liver
604
Are water soluble vitamins toxic?
Not toxic – not stored by the body
605
What are the food sources of B vitamins?
Grains, cereals, breads, and meats
606
What are the benefits of water soluble vitamins?
A sense of well-being and increased energy, decreased anger, tension and irritability
607
What are the food sources of Vitamin C?
Fruits and green vegetables
608
What happens to Vitamin C when cooked?
Lose a large amount of vitamin C
609
What is the function of Vitamin A (Retinol)?
Maintenance of healthy eyes, immune function, and cell growth
610
What are the food sources of Vitamin A?
Darkly colored fruits and vegetables including carrots
611
What is the first indication of Vitamin A deficiency?
Night blindness
612
What are the excess conditions of Vitamin A?
Visual changes, joint pain, liver damage and birth defects
613
What is the function of Vitamin D (Cholecalciferol)?
Essential for phosphorus and calcium absorption; Important for strong teeth and bones
614
What are the deficiency conditions of Vitamin D?
Rickets in children, decreased bone density, developmental delays, seizures, skeletal deformity, osteomalacia in adults
615
What are the excess conditions of Vitamin D?
Hypercalcemia
616
What is the function of Vitamin E (Alpha-tocopherol)?
Acts as an antioxidant and immune enhancement
617
What are the food sources of Vitamin E?
Sunflower seeds, green leafy vegetables
618
What are the deficiency conditions of Vitamin E?
Hemolytic anemia, peripheral neuropathies, impairment of the immune response
619
What are the excess conditions of Vitamin E?
Bleeding (too much E)
620
What is the function of Vitamin K (Phytonadione)?
Essential for blood clotting
621
What are the food sources of Vitamin K?
Leafy green vegetables, vegetable oil
622
What are the deficiency conditions of Vitamin K?
Increased bleeding
623
What can excess Vitamin K cause?
Excess can cause blood clots
624
What is important to maintain when taking warfarin?
Importance of maintaining consistent intake of vitamin K
625
What is the food source for Vitamin B1 (Thiamine)?
Pork
## Footnote
Vitamin B1 is primarily found in pork.
626
What are the deficiency conditions associated with Vitamin B1 (Thiamine)?
* Beriberi (Cardiovascular, Neurological, Psychological symptoms)
* Wernicke encephalopathy (Mental Confusion, Neurological)
## Footnote
Beriberi and Wernicke encephalopathy are serious conditions resulting from Vitamin B1 deficiency.
627
What is the function of Vitamin B2 (Riboflavin)?
Tissue integrity
## Footnote
Vitamin B2 is essential for maintaining the integrity of tissues.
628
What deficiency condition is associated with Vitamin B2 (Riboflavin)?
Dry/cracked skin at the corners of the mouth
## Footnote
This condition is a sign of riboflavin deficiency.
629
What is the function of Vitamin B3 (Niacin)?
In all body tissues; nervous system, lowers lipid/LDL
## Footnote
Niacin plays a critical role in various bodily functions, including lipid metabolism.
630
What deficiency condition is associated with Vitamin B3 (Niacin)?
Pellagra (rough skin)
## Footnote
Pellagra is characterized by a rough skin condition due to niacin deficiency.
631
What are the excess conditions associated with Vitamin B3 (Niacin)?
* Flushing
* Itching
* Liver damage
## Footnote
High doses of niacin can lead to significant side effects.
632
What is the function of Vitamin B5 (Pantothenic Acid)?
Gluconeogenesis – non-carbohydrate molecules into glucose in liver
## Footnote
Vitamin B5 is crucial for converting non-carbohydrate sources into glucose.
633
What is the food source for Vitamin B5 (Pantothenic Acid)?
Beans
## Footnote
Beans are a primary source of pantothenic acid.
634
What is the function of Vitamin B6 (Pyridoxine)?
* Required for carbohydrate and lipid metabolism
* Protein synthesis
* RBC formation
* Proper nerve function
## Footnote
Vitamin B6 is involved in many metabolic processes.
635
What deficiency conditions are associated with Vitamin B6 (Pyridoxine)?
* Neuritis
* Anemia
## Footnote
Vitamin B6 deficiency can lead to nerve-related issues and anemia.
636
What can interfere with Vitamin B6 metabolism?
Isoniazid (INH)
## Footnote
Isoniazid is a medication that affects B6 metabolism.
637
What are the excess conditions associated with Vitamin B6 (Pyridoxine)?
Peripheral neuropathy (numbness, tingling)
## Footnote
Excessive B6 intake can cause peripheral nerve damage.
638
What is the function of Vitamin B7 (Biotin)?
Metabolism and synthesis of fats, carbs, and amino acids for energy production
## Footnote
Biotin is essential for energy metabolism.
639
What is the function of Vitamin B9 (Folic Acid)?
* Essential in DNA synthesis
* Prevents fetal problems
* Part of preconception planning
## Footnote
Folic acid is vital for DNA synthesis and fetal health.
640
What are the excess conditions associated with Vitamin B9 (Folic Acid)?
Taking higher amounts can mask a vitamin B12 deficiency
## Footnote
Excessive folic acid intake can hide symptoms of B12 deficiency.
641
What is the function of Vitamin B12 (Cobalamin)?
DNA synthesis; development of RBCs in bone marrow
## Footnote
Vitamin B12 is critical for DNA synthesis and red blood cell production.
642
What are the deficiency conditions associated with Vitamin B12 (Cobalamin)?
* GI disorders
* Anemia
* Pernicious anemia
## Footnote
Deficiencies in B12 can lead to serious health issues.
643
Where is Vitamin B12 primarily absorbed?
Ileum
## Footnote
The ileum is the primary site for B12 absorption.
644
What can cause Vitamin B12 deficiency?
* Malabsorption syndromes
* Metformin
* Proton pump inhibitors
## Footnote
Certain conditions and medications can lead to B12 deficiency.
645
What is the function of Vitamin C (Ascorbic Acid)?
* Antioxidant
* Aids iron absorption
* Essential for tissue repair/growth
* Collagen formation
* Immune function
## Footnote
Vitamin C plays multiple roles in maintaining health.
646
What are the deficiency conditions associated with Vitamin C (Ascorbic Acid)?
* Poor wound healing
* Bleeding gums
* Scurvy
* Faulty bone/tooth development
## Footnote
Scurvy is a classic deficiency disease of Vitamin C.
647
What is the function of Iron (Fe) – Ferrous Sulfate?
Needed for RBC formation
## Footnote
Iron is crucial for the production of red blood cells.
648
What are the deficiency conditions associated with Iron (Fe)?
* Fatigue
* Weakness
* SOB
* Tachycardia
* Pallor
* Cold hands/feet
* Microcytic/hypochromic anemia
* Increased GI bleeding
## Footnote
Iron deficiency can lead to various symptoms, primarily related to anemia.
649
What are the excess conditions associated with Iron (Fe)?
* Serious poisoning in children
* Ulcerogenic hemorrhage
* N/V/D
* Tarry stools
* Hematemesis
* Pallor
* Cyanosis
* Shock
* Coma
## Footnote
Excessive iron intake can be toxic and lead to severe health issues.
650
What are the side effects of Iron (Fe)?
* N/V/D
* Constipation
* Epigastric pain
* Elixir may stain teeth
## Footnote
Iron supplements can cause gastrointestinal discomfort and staining.
651
What is the function of Copper?
* Needed for RBC formation
* Cofactor for enzymes
* Production of norepinephrine and dopamine
## Footnote
Copper is essential for various enzymatic processes and neurotransmitter production.
652
What deficiency conditions are associated with Copper?
* Anemia unresponsive to iron
* Abnormal blood/skin changes
* Mental retardation in young
## Footnote
Copper deficiency can lead to serious health consequences, including developmental issues.
653
What excess condition is associated with Copper?
Wilson disease – accumulation in liver, kidneys, brain, cornea
## Footnote
Wilson disease is a genetic disorder leading to copper accumulation.
654
What is the function of Zinc?
* Enzymatic reactions
* Growth
* Appetite
* Skin integrity
* Wound healing
## Footnote
Zinc is involved in numerous biological processes.
655
What should be noted regarding Zinc and antibiotics?
Zinc and antibiotics should be taken 2 hours apart
## Footnote
This separation helps avoid interaction that could affect absorption.
656
What deficiency context is associated with Zinc?
Total parenteral nutrition (TPN)
## Footnote
Zinc deficiency can occur in patients receiving TPN without adequate supplementation.
657
What is the function of Chromium (Cr3+)?
* Carb, lipid, nucleic acid metabolism
* Increases insulin effects
## Footnote
Chromium plays a role in enhancing insulin sensitivity.
658
What deficiency conditions are associated with Chromium?
* Craving sweets
* Excessive thirst
## Footnote
Chromium deficiency can lead to metabolic disturbances.
659
What are the excess conditions associated with Chromium?
* GI bleeding
* Coagulopathy
* Seizures
* Pulmonary dysfunction
## Footnote
Excess chromium can lead to serious health risks.
660
What is the function of Selenium (Se)?
* Antioxidant
* Reproduction
* Thyroid hormone metabolism (T4 & T3)
* DNA synthesis
* Immune defense
## Footnote
Selenium is vital for various physiological functions, including thyroid health.
661
What deficiency condition is associated with Selenium?
Hypothyroidism
## Footnote
Selenium deficiency can contribute to thyroid dysfunction.
662
What are the excess conditions associated with Selenium?
Selenium toxicity
## Footnote
Excess selenium can lead to toxic effects in the body.
