Chap 36 (Exam 4) Flashcards Preview

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Flashcards in Chap 36 (Exam 4) Deck (51):
1

The nurse who is providing patient teaching about antihistamine use will include which information? Select all that apply:
Antihistamines are best tolerated when taken with meals
The patient can chew gum if he or she experiences dry mouth
Drowsiness is a frequent side effect of antihistamines
Over the counter medications are generally safe to use with antihistamines
The patient should avoid drinking alcoholic beverages while on these drugs

Antihistamines are best tolerated when taken with meals
The patient can chew gum if he or she experiences dry mouth
Drowsiness is a frequent side effect of antihistamines
The patient should avoid drinking alcoholic beverages while on these drugs

2

A patient asks the nurse about the newer antihistamines. He wants one that does not cause drowsiness. Which of these drugs is appropriate?
Loratadine (Claritin)
Diphenhydramine (Benadryl)
Dimenhydrinate (Dramamine)
Meclizine (Antivert)

Loratadine (Claritin)

3

Which drugs are considered first-line drugs for the treatment of nasal congestion? Select all that apply
Antihistamines such as diphenhydramine
Decongestants such as naphazoline
Antitussives such as dextromethorphan
Expectorants such as guaifenesin
Inhaled corticosteroids such as beclomethasone

Decongestants such as naphazoline
Inhaled corticosteroids such as beclomethasone

4

When giving an antitussive, the nurse remembers that they are used primarily for what reason?
To relieve nasal congestion
To thin secretions to ease removal of excessive secretions
To stop the cough reflex when the cough is nonproductive
To suppress productive and nonproductive coughs

To stop the cough reflex when the cough is nonproductive

5

The nurse is administering an expectorant and will provide which teaching?
Avoid fluids for 30-35 minutes after the dose
Drink extra fluids, unless contraindicated, to aid in expectoration of sputum
Avoid driving or operating heavy machinery while taking this medication
Expect secretions to become thicker

Drink extra fluids, unless contraindicated, to aid in expectoration of sputum

6

A patient has been self-medicating with diphenhydramine (Benadryl) to help her sleep. She calls the clinic nurse to ask, "Why do I feel so tired during the day after I take this pill? I get a good night's sleep!" Which statement by the nurse is correct?
"You are probably getting too much sleep"
"You are taking too much of the drug"
"This drug is not really meant to help people sleep"
"This drug often causes a 'hangover effect' during the day after taking it"

"This drug often causes a 'hangover effect' during the day after taking it"

7

A patient is asking about taking an antihistamine for springtime allergies. The nurse assesses for contraindications to antihistamine therapy. Which of these conditions, if present, would be a contraindication? Select all that apply:
Type 2 diabetes mellitus
Benign prostatic hyperplasia
Hyperthyroidism
Narrow- angle glaucoma
Asthma

Benign prostatic hyperplasia
Narrow- angle glaucoma
Asthma

8

Mrs. L was seen in the office several days ago with a common cold. She has been on decongestant therapy with naphazoline nasal spray (Privine) since that time. Today she calls to say, "I thought I was getting over this, but suddenly my nose is more stuffed up than ever." Does Mrs. L possibly need a stronger dosage of the decongestant? Explain your answer.

No, Mrs. L is likely experiencing rebound congestion caused by sustained use of the naphazoline for several days

9

Keith has been using a topical nasal decongestant for the past few days. He calls the health care provider's office to report that he is feeling nervous and dizzy and that his heart seems to be racing. What might be the cause of Keith's symptoms?

Keith is exhibiting symptoms of the cardiovascular effects that can occur when a topically applied adrenergic nasal decongestant is absorbed into the bloodstream. Usually the amount absorbed is too small to cause systemic effects at normal dosages. Excessive dosages of these medications, however, are more likely to cause systemic effects elsewhere in the body. These may include cardiovascular effects such as hypertension and palpitations and CNS effects such as headache, nervousness, and dizziness. These systemic effects are the result of alpha-adrenergic stimulation of the heart, blood vessels, and CNS.

10

How does benzonatate (Tessalon Perles) differ from other antitussive drugs in its mechanism of action? In its drug interaction profile?

Benzonatate's mechanism of action is entirely different from that of the other drugs. It suppresses the cough reflex by numbing the stretch receptors, which keeps the cough reflex from being stimulated in the medulla. It is associated with fewer drugs interactions than the opioid antitussives and dextromethorphan

11

One day the nurse encounters her neighbor Irene as she is returning home from work. Irene is on her way to the drugstore, she tells the nurse, because she has been experiencing a nonproductive cough and wants to get a cough medicine "to loosen things up." The nurse recalls that Irene mentioned a few months ago that she has problems with her thyroid. How should the nurse respond to Irene's comment? Explain your answer.

The nurse will ask Irene whether she is taking any thyroid medication or whether she has cardiac disease, glaucoma or hypertension. A drug interaction can occur if she takes dextromethorphan (an antitussive) with an antithyroid drug. The other conditions listed are contraindications. Irene should call her health care provider before she goes to the drugstore.

12

Lisa is a 5-year-old patient who has bronchitis accompanied by a nonproductive cough. The provider has prescribed Robitussin DM for the cough. Lisa's father tells the nurse that his 11-year-old son was prescribed Robitussin A-C several months earlier for a severe cough. He asks whether his son's cough medicine would help Lisa because "there's plenty left in the bottle." What will the nurse tell him?

First, Lisa's brother received Robitussin A-C, an opioid antitussive containing codeine, for his cough. Lisa has been prescribed Robitussin, an expectorant, for her nonproductive cough associated with bronchitis. Second, even if the two children were prescribed the same drug, Lisa is only 5 years old and requires a smaller dosage than her brother. Prescription medications should not be shared among family members

13

Britney gave birth recently and is breastfeeding her baby. She calls the pediatrician's office because she wants to take an over-the-counter antihistamine for her allergies. "It's okay now that I've given birth, right?" What is the nurse's best answer?

Antihistamines should generally be used with caution in lactating mothers. The decision will be made by weighing the drug's potential effect on the baby versus the need for her to take the medication.

14

James, a 35 year old electrician, is seen in the emergency department with a rash on his arms and hands that appeared after he was working in his yard. You suspect that the physician will prescribe topical diphenhydramine (Benadryl), but during the nurse assessment, James tells you that he has diabetes.
How does James's diabetes affect his possible treatment with diphenhydramine?

James's diabetes should not affect his treatment

15

James, a 35 year old electrician, is seen in the emergency department with a rash on his arms and hands that appeared after he was working in his yard. You suspect that the physician will prescribe topical diphenhydramine (Benadryl), but during the nurse assessment, James tells you that he has diabetes.
If James does receive a topical diphenhydramine preparation, what other drug might be found in combination with it?

The topical diphenhydramine might come in combination with a drug such as calamine, camphor or zinc oxide

16

James, a 35 year old electrician, is seen in the emergency department with a rash on his arms and hands that appeared after he was working in his yard. You suspect that the physician will prescribe topical diphenhydramine (Benadryl), but during the nurse assessment, James tells you that he has diabetes.
The topical medication did not help his rash, and James has been switched to oral diphenhydramine. He tells you that he expects to return to work tomorrow and hopes this medication "does the trick."
What cautions, if any, should James be aware of while taking this medication?

He should be informed that taking any of the sedating antihistamines may cause drowsiness, and so he should be instructed to avoid driving or operating heavy machinery should these side effects occur or until he knows how he responds to the medication

17

James, a 35 year old electrician, is seen in the emergency department with a rash on his arms and hands that appeared after he was working in his yard. You suspect that the physician will prescribe topical diphenhydramine (Benadryl), but during the nurse assessment, James tells you that he has diabetes.
The topical medication did not help his rash, and James has been switched to oral diphenhydramine. He tells you that he expects to return to work tomorrow and hopes this medication "does the trick."
Are there any concerns with drug interactions?

James should also be informed not to consume alcohol or take other central nervous system depressants because they may interact with the diphenhydramine to exacerbate drowsiness and sedation.

18

When assessing a patient who is to receive a decongestant, the nurse will recognize that a potential contraindication to this drug would be which condition?
Glaucoma
Fever
Peptic ulcer disease
Allergic rhinitis

Glaucoma

19

When giving decongestants, the nurse must remember that these drugs have alpha-adrenergic-stimulating effects that may result in which effect?
Fever
Bradycardia
Hypertension
CNS depression

Hypertension

20

The nurse is reviewing a patient's medication orders for prn (as necessary) medications that can be given to a patient who has bronchitis with a productive cough. Which drug will the nurse choose?
An antitussive
An expectorant
An antihistamine
A decongestant

An expectorant

21

The nurse knows that an antitussive cough medication would be the best choice for which patient?
A patient with a productive cough
A patient with chronic paranasal sinusitis
A patient who has had recent abdominal surgery
A patient who has influenza

A patient who has had recent abdominal surgery

22

A patient is taking a decongestant to help reduce symptoms of a cold. The nurse will instruct the patient to observe for which possible symptom, which may indicate an adverse effect of this drug?
Increased cough
Dry mouth
Slower heart rate
Heart palpitations

Heart palpitations

23

The nurse is giving an antihistamine and will observe the patient for which side effects? Select all that apply
Hypertension
Dizziness
"Hangover" effect
Drowsiness
Tachycardia
Dry mouth

Dizziness
"Hangover" effect
Drowsiness
Dry mouth

24

Antihistamine Indications?

Nasal allergies
Seasonal or perennial allergic rhinitis
Symptoms of common cold
Allergic reactions
motion sickness
Parkinson's disease (anticholinergic drying effects)
Vertigo

25

Diphenhydramine

Benadryl
Traditional antihistamine
Works peripherally & centrally
Has anticholinergic & sedative effects
Hangover effect
Used w/ epinephrine for anaphylaxis

26

Chlorpheniramine

generic
Antihistamine

27

Fexofenadine

Allegra
Not recommended in renal impairment
Antihistamine

28

Loratadine

Claritin
Nonsedating antihistamine
Taken once a day
Works peripherally
Higher doses= CNS effects= drowsiness, headache, fatigue

29

Cetirizine

Zyrtec
Antihistamine

30

Antihistamine Contraindications?

Narrow angle glaucoma
Hypertension
Cardiac disease
Kidney disease
Bronchial asthma
COPD
peptic ulcer disease
Seizure disorders
BPH
Pregnancy

31

Antihistamine Adverse Effects

Drowsiness (chief complaint)
Dry mouth
Changes in vision
Difficulty urinating
Constipation

32

Beclomethasone dupropionate

Beconase
Decongestant

33

Budesonide

Rhinocort
Decongestant

34

Flunisolide

Nasalide
Decongestant

35

Fluticasone

Flonase
Decongestant

36

Ciclesonide

Omnaris
Decongestant

37

Decongestant Contraindications

Drug allergy
Narrow angle glaucoma
Uncontrolled cardiovascular disease
Hypertension
Diabetes
Hyperthyroidism
Prostatitis
Pts can't close eyes do to CVA
Transient ischemic attacks
Cerebral arteriosclerosis
Long standing asthma
BPH

38

Oral decongestant benefits

Prolonged effect
Delayed onset
Less potent than topical routes
Gradual increase & decrease in pharmocological activity

39

Decongestant Adverse Effects

Nervousness
Tremor
Insomnia
Palpitations
Intranasal steroids= mucosal irritation, dryness
Topically excessive doses= HTN, palpitations, headaches, nervousness, dizziness

40

Decongestant interactions

Sympathomimetic drugs & sympathomimetic nasal decongestants cause toxicity
MAOIs= additive pressor effects (increase BP)

41

Naphazoline

Privine
nasal administration
cause arterioles to constrict, reducing nasal flow, allowing draining, and congestion relief

42

Opioid Antitussive mechanism of action

Suppress cough reflex at cough center in medulla
Drying effect on mucosa
Increase respiratory secretion viscosity
Analgesic effect

43

Nonopioid antitussive mechanism of action

Dextromethorphan: suppress cough reflex at cough center in medulla
Benzonatate: numb stretch receptors in respiratory tract
No analgesic effect
No CNS depression

44

Dextromethorphan Contraindications

Drug allergy
Hyperthyroidism
Advanced cardiac and vessel disease
HTN
Glaucome
MAOIs in last 14 days
Asthma or emphysema
Persistent headache

45

Codeine & hydrocodone Contraindications

w/ alcohol use
CNS depression
anoxia
hypercapnia
respiratory depression
increased intracranial pressure
impaired renal function
liver disease
BPH
Addison's disesae
COPD

46

Dextromethorphan adverse effects

Dizziness
drowsiness
nausea

47

Benzonatate adverse effects

dizziness
headache
sedation
nausea
constipation
pruritus
nasal congestion

48

Codeine & hydrocodone adverse effects

sedation
nausea
vomiting
lightheadedness
constipation

49

Benzonatate

Tessalon Perles
Nonopioid antitussive
oral
numb stretch receptors

50

Expectorant indications

relief of productive cough with
Common cold
bronchitis
laryngitis
pharyngitis
pertussis
influenza
measles

51

Guaifenesin

Mucinex
Adverse effects= nausea, vomiting, gastric irritation
short half life
thins mucus in the respiratory tract