Test 5

Question 1

Antihistamine receptors, side effects, patient teaching

Answer 1

H1 receptor blocker
SE: Drowsiness, dry mouth, urinary retention, hypotension, tachycardia, constipation, often stimulatory in children
Pt Teaching: Avoid alcohol and opioids, fall risk in older adults, take before s/s of allergies,not for children because of idiosyncratic effects

Question 2

guaifenesin (Mucinex) therapeutic indication, mechanism of action

Answer 2

I: dry non-productive cough
MOA: Increase expelling of bronchial secretions by thinning Mucus

Question 3

Inhalation therapy patient teaching, rationale for using this route

Answer 3

pt: ○ Prime spray
○ Clear nasal passage
○ Insert the tip aiming high in the nasal cavity and toward the back of head
○ Close the opposite nostril, breathe in slowly and spray
○ Spit out any excess liquid.

Inhalation offers rapid and efficient bronchodilation directly to the site of action in the lungs, dramatically decreasing the onset of action *can also use lower dose
The enormous surface area of the bronchioles and alveoli and the rich blood supply to these areas results in an almost instantaneous onset of action with little systemic toxicity

Question 4

oxymetazoline (Afrin) teaching, complications

Answer 4

pt: *if coronary artery disease-get doc approval, don’t use for longer than 3-5 days! to avoid rebound congestion. if using a corticosteroid use sympathomimetic first then wait a minute for cortico.
C: htn, rebound congestion (hypersecretion of mucous/swelling), dries mucous membranes.

Question 5

Oral and intranasal route differences in general

Answer 5

Most oral decongestants are sympathomimetics (adrenergic drugs) nnm
○ Many combination drugs, but single dose is safer
○ Oral have a longer onset of action
○ Intranasal drugs are deliverd via sprays directly to their site of action which offers
rapid and efficient relief.
○ Oral more likely for systemic effects

Question 6

Pseudoephedrine (Sudafed) patient teaching

Answer 6

pt: monitor hr-tachycardia, bp-htn, palpitation, dysthymias-cardiac disease pts
tracked betweeen pharmacies
possible s/e hypertension, cns stim (anxiety, insomnia, urinary retention-if pre existing issues. )

Question 7

Asthma medication treatment goals

Answer 7

*asthma drugs
moa
where it works (mucus membrane, bronchioles, etc.)
route of administration
Goal: Terminate acute bronchospasms and to reduce the frequency of asthma attacks

Question 8

Dry powder inhalation (DPI) mechanism

Answer 8

○ Offers rapid and efficient bronchodilation directly to the site of action in the lungs,
dramatically decreasing the onset of action
○ Large surface area and rich blood supply of bronchioles and alveoli mean almost
instantaneous onset of action with little systemic toxicity
○ Activated by inhalation
○ Have longer duration of action
○ Easier to use- less complex for pts

Question 9

albuterol (Proventil) indication, side effects, mechanism of action, patient teaching

Answer 9

I: acute bronchospasm - most effective
SE: tachycardia, dysrhythmias, tremors, anxiety, headache, throat irritation, hyperglycemia
MOA: activate B2 receptors which causes bronchodilation, Stimulates SNS, Widens airways
Pt teaching: use correct technique, use at first sign of asthma attack, label as rescue inhaler

Question 10

Glucocorticoid inhalation side effects

Answer 10

Hoarseness, dry mouth, thrush, long term use: cataracts

Question 11

Leukotriene modifiers [zafirlukast (Accolate)] indication

Answer 11

I: Prophylaxis of persistent chronic asthma. Decrease inflammation in lungs

Question 12

ipratropium (Atrovent) contraindication, patient teaching

Answer 12

C: *no use in children under 12
propellent is may of soy lecithin (no use if soy or peanut allergy),
Assess for history of narrow-angleglaucoma, benign prostatic hyperplasia, renal disorders, urinary bladder neck obstruction
◦ Contraindicated in clients with history of these and in elderly
Pt: keep away from eyes, s/e *few systemic. Headache, bitter taste (rinse), dry cough, dry mouth, irritate mucous membranes in throat (airway irritation)
Note: more effective when used in combination with beta agonists, specifically LABA’S ) *results in longer duration of action.

Question 13

GERD treatment goal

Answer 13

G: reduce gastric acid secretion

Question 14

H2-receptor antagonist indication, mechanism or action

Answer 14

I: peptic ulcer disease and GERD
MOA: acid reduction via Decrease of acid secretion from parietal cells

Question 15

ranitidine (Zantac) patient teaching

Answer 15

pt: ○ H2 receptor antagonist
○ Don’t take at same time as PPIs and antacids
○ Take c meal or at bedtime, best c food

Question 16

bismuth (Pepto-Bismol) indication, mechanism of action

Answer 16

I: peptic ulcer disease, diarrhea
MOA: stimulates mucosal bicarbonate and prostaglandin productions which prevents H. pylori from adhering to intestinal mucosa, absorbs toxins, can also destroy H. pylori cell wall

Question 17

misoprostol (Cytotec) indications

Answer 17

I: Peptic ulcer disease and sometimes labor

Inhibits gastric acid secretion and stimulates production of protective mucosa
Also used for labor induction Pregnancy Category X (ripens cervix) do not use in pregnancy

Question 18

omeprazole (Prilosec) classification

Answer 18

Class: PPI (acid reducer)

○ Binds to the enzyme that is responsible for secreting hydrochloric acid
○ Monitor for osteoporosis (less acid less calcium absorption)
○ Monitor liver function- PPIs can cause liver disease and problems
○ Several drug/drug interactions: cumedin (Warfarin), antivirals, anti-depressants
○ Administration: 20-30 min before meal on empty stomach (1-2 times a day) best
c food
○ Most PPIs end in “prazole”

Question 19

sucralfate (Carafate) administration

Answer 19

sucralfate (Carafate)-Protective coating *mostly liquid, protects stomach allowing to heal.
Take on epty stomach

Question 20

diphenoxylate with atropine (Lomotil) mechanism of action

Answer 20

Used to treat diarrhea
Diphenoxylate is a synthetic opioid receptor agonist and acts on opioid receptors in the GI tract and reduces GI motility and slows down movement of contents in intestines.
Atropine is anticholinergic and blocks the action of acetylcholine

Question 21

Laxatives general patient teaching, mechanism of action

Answer 21

Teaching: Follow dosing instructions from the provider, hydrate well, explain that it may take time to work so do not give up if it doesn’t work immediately, get more dietary fiber, encourage regular physical activity, and avoid excessive use. Inform side effects may include abdominal cramping, diarrhea, nausea, or bowel habit changes. Do not abuse.
MOA:
- Bulk-forming laxatives: contain fiber or other substances that absorb water in intestines, softening stool and adding bulk, which stimulates peristalsis
- Stool-softeners/emollient laxatives: increase water content of stool which makes it softer and easier to pass.
- Lubricant laxatives: coat the surface of stool and intestines, making it easier for stool to move through digestive tract. Also prevents water absorption from the stool
- Osmotic laxatives: draws water into intestines, which softens stool and increases stool volume
- Saline laxatives: contains salts and mineral ions that draw water into the intestines which softens stool
- Stimulant laxatives: irritates intestinal lining, which stimulates peristalsis and secretion of fluids into the intestines to soften stool.
- Prokinetic agents: enhance muscular contractions of intestines

Question 22

Treatment standards for inflammatory bowel disease

Answer 22

Ulcerative Colitis large intestine -ulcers in mucoss
Chron’s Disease small intestine- fat wrapping, muscle hypertrophy, fissues, cobblestone
Mild to acute flare ups
Remissions and exacerbation
Treatment- with immunosuppressants and anti-inflammatory drugs
First step 5-aminosalicylic acid drugs *rapid releif, antiinflammatory properties
Examples: sulfasalazine (Azulfidine), mesalamine (Asacol)-more common
2nd stepc corticosteroids
Example: budesonide (Entocort EC) usually given liquide
3rd step immunosupressents
Example: azathioprine (Imuran)
Biologic therapy binds with and prevents activity of Tumor Necrotic Factor which is involved in producing inflammation. Name 2 examples:
infliximab (remicade)
adalimumab (humira)

Question 23

prochlorperazine (Compazine) side effects

Answer 23

Antipsychotic medication used to manage schizophrenia and nausea/vomiting from surgery or chemo.
S/E: Drowsiness, sedation, dry mouth, blurred vision, dizziness or lightheadedness, constipation, weight gain, difficulty urinating, EPS, NMS, hypotension, elevated prolactin

Question 24

B12 deficiency causes and complications

Answer 24

Causes: Inadequate dietary intake, impaired digestive absorption, GI disorders (Crohns, celiac, atrophic gastritis), aging, GI surgery, parasites, alcoholism
Complications: Pernicious anemia (B12 helps create blood cells), neurological/cognitive issues, neuropathy, optic nerve damage, heart problems, psychiatric issues

Question 25

Common causes of vitamin deficiencies

Answer 25

Most commonly caused by dietary deficiencies or absorption issues.

Question 26

Calcium absorption

Answer 26

○ Aging population especially needs calcium
○ Vitamin D needed to absorb calcium
○ PPIs decrease calcium absorption

Question 27

Lipid soluble vitamin side effects

Answer 27

Vitamin A: Uncommon but notify doctor of difficulty breathing; hives; swelling of the lips, face, or tongue; or closing of the throat.
Vitamin D: Deficiency causes osteoporosis. At higher doses can cause fatigue, weakness, dizziness,
ataxia, muscle and joint pain, hypotonia (infants), pruritus, headache, drowsiness, photophobia, or convulsions, anorexia, nausea and vomiting, diarrhea, metallic taste, dry mouth, constipation, and abdominal cramps. Some patients present with anemia. Musculoskeletal symptoms include calcification of soft tissues in the kidneys, myocardium, lungs, or skin. Acute kidney injury could occur with symptoms such as polyuria, polydipsia, albuminuria, and hematuria.
Vitamin E: With excessive use: fatigue, headache, skeletal muscle weakness, nausea, diarrhea, intestinal cramps, thrombophlebitis, contact dermatitis, blurred vision, or abnormal bleeding. With toxic levels laboratory tests may reveal increased serum creatine kinase, cholesterol, and triglycerides; decreased serum thyroxine and tri-iodothyronine; increased urinary estrogens and androgens; and creatinuria.
Vitamin K: after PO dosing include headache, GI upset, paradoxical hypoprothrombinemia (in patients with severe liver disease), severe hemolytic anemia, hyperbilirubinemia, kernicterus, bronchospasm, and dyspnea.
Black Box Warning: Severe reactions such as shock, anaphylaxis, and cardiac arrest have occurred when vitamin K is given by the intravenous (IV) or intramuscular (IM) route.

Question 28

Total Parenteral Nutrition (TPN) treatment guidelines, complications

Answer 28

Parenteral Feedings used when unable to meet needs through enteral route, gut disfuncition/need to rest
Delivered via iv (central or PICC) *cannot be given via peripheral iv because of high concentration
*very expensive, need to draw labs, custom per person
Complications
Infection: Check for fever, infection at site, blood count, etc
High blood glucose: Check bg q4
Fluid imbalances: Check fluid levels and daily weights

Question 29

orlistat (Alli) side effects

Answer 29

Class: Antilipase or Antiobesity drug
S/E: Flatus with discharge, oily stools, fecal urgency (these four especially during 4 weeks of therapy). Rare cases of liver toxicity.