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Pharm 2 > Final Exam > Flashcards

Final Exam Flashcards

(66 cards)

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1
Q

Know which labs to monitor for a patient taking diuretics

A

*Potassium (3.5-5)
*Sodium (135-145)
Electrolytes
Blood Glucose
Uric Acid Levels
BUN/Creatinine

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2
Q

Review nursing interventions for older adult patients taking diuretics

A

Caution older adults d/t increased risk of fluid/electrolyte imbalances
Monitor s/s of hyperkalemia, hypokalemia, dehydration
➢ s/s hyperkalemia: muscle twitches, irritability, EKG changes
➢ s/s hypokalemia: muscle weakness, cardiac dysrhythmias, decreased motility
Change position slowly

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3
Q

Know when (times of day) to teach patients to take their diuretic drugs

A

Beginning of the day/ several hours before bed

NEVER right before bed

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4
Q

Review patient teaching for digoxin (Lanoxin)

A

*Toxicity→ Reports Nausea, loss of appetite, vomiting, HA, visual disturbances, heart palpitations
Frequent labs drawn → electrolytes and digoxin levels
● LOW K+ or Mg → can INCREASE risk of toxicity
Do not administer med if HR is <60bpm, call provider
Take at same time every day (don’t skip or double dose)

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5
Q

Know AE’s of milrinone (Primacor)

A 
*Ventricular Dysrhythmias > occur in 12% of clients
Hypokalemia
Hypotension
Anginal chest pain
Tremor
Thrombocytopenia
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6
Q

Review drug interactions of milrinone (Primacor)

A

Do not inject furosemide into IV line c milrinone as it will precipitate and cause phlebitis**
Concurrent use of diuretics may cause significant hypovolemia and reduced cardiac filling pressure
Additive inotropic effect with concurrent use of digoxin

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7
Q

Know therapeutic effects of antidysrhythmic drugs

A

Normal sinus rhythm
BP normal
Reduce dysrhythmias

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8
Q

Review patient teaching for adenosine (Adenocard)

A

Can cause short Asystole from short half life

Not for long term use

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9
Q

Know the indications for verapamil (Calan)

A

Convert SVT to normal sinus

Slow HR in A-Fib and A-Flutter

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10
Q

Review AE’s of quinidine (Quinide)

A 
*Cinchonism (tinnitus, visual disturbances, HA, N/V)
GI
Hypotension
Ventricular dysrhythmias
Arterial embolism
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11
Q

Identify when to use nitrates (nitroglycerin) cautiously

A

Viagra (Sildenafil) – increased risk for HoTN

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12
Q

Know the proper methods for storage of oral (PO) nitroglycerin

A

Good for up to 24 months

Glass bottle, away from heat/light – best in bathroom med cabinet

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13
Q

Review nursing interventions for the correct administration of IV nitroglycerin

A

Needs to be in special tubing – protect from heat/light
HA→ may give a mild analgesic to treat nitro HA
Monitor for Drug tolerance→ give lowest dose possible, tolerance develops quickly

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14
Q

Know therapeutic INR values for the patient taking warfarin (Coumadin)

A

Normal: 1.1 or below
Therapeutic: 2-3 (avg = 2.5)
➢ those with reoccurring clots 2.5-3.5 (avg = 3)

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15
Q

Know the antidote for warfarin (Coumadin) and heparin

A

Warfarin Antidote🡪 Vitamin K

Heparin Antidote🡪 IV protamine sulfate

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16
Q

Review the steps for the correct administration of enoxaparin (Lovenox)

A

*Administer air bubble in pre-filled syringe
Rotate sites
2 inches from the umbilicus
Aseptic technique

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17
Q

Review the complications that can occur in a patient with heparin-induced thrombocytopenia

A 
Fatal because clots can form 
Acute drop in platelet count = risk of acute drop in WBC, RBC, and sudden bleeding
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18
Q

Know patient teaching for clopidogrel (Plavix)

A 
*Report s/s of excessive bleeding (TTP)
Can take c food, 8 oz of water, or milk to reduce GI adverse effects
Report persistent GI pain
*No alcohol
Stop before surgery
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19
Q

Review AE’s of atorvastatin (Lipitor)

A

*Myopathy🡪 rhabdomyolysis

If pt develops this, therapy will be stopped

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20
Q

Know contraindications for antilipemic drugs

A

*Liver disease/elevated liver enzymes

Pregnancy

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21
Q

Review drug-drug interactions for gemfibrozil (Lopid)

A

Warfarin – increased risk for bleeding

Statin and fibrate – increased risk for myopathy

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22
Q

Understand nursing interventions with sedating antihistamines

A

Take at bedtime – causes drowsiness and fall risk
Anticholinergic effects (can’t see…)
Interactions → CNS depressants

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23
Q

Know indications for each type of antitussive/expectorant

A

Codeine🡪 used for suppression of non-productive cough r.t allergies or URI (opioid antitussive)
Dextromethorphan (Delsym)🡪 used to suppress non-productive cough r/t allergies or URI (Non-opioid antitussive)
Guaifenesin (Mucinex)🡪 used for productive cough r/t colds, URI, bronchitis, pneumonia (expectorant)
Acetylcysteine (Acetadote) 🡪 used for bronchopulmonary disease, CF, acetaminophen overdose

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24
Q

Know priority patient education regarding acetylcysteine

A

Increase fluids
Expect sulfur-like odor
Have suction available
No metal/rubber parts

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25
Know adverse effects associated with phenylephrine and codeine
Phenylephrine - rebound nasal congestion, short term (3-5 days) Codeine - CNS/Resp depression, constipation, N/V, dizziness
26
Understand patient education regarding theophylline and QVAR
Theophylline - NO char-broiled food, caffeine, high protein, low carb, scheduled not PRN (not rescue) QVAR - use after albuterol, Scheduled not PRN, use spacer
27
Know therapeutic blood levels for theophylline
5-15 mcg/ml
28
Know the indications for montelukast (Singulair)
Chronic asthma Allergies Before exercise Allergic rhinitis
29
Know which medication is used for an acute asthma attack or a “rescue” inhaler
Albuterol
30
Know indications for oxybutynin (Ditropan)
Urinary incontinence
31
Review therapeutic outcomes and indications for bethanechol (Urecholine)
Indicated for urinary retention r/t surgery,post-childbirth,lack of neurogenic bladder innervation. Urinary voiding, increased GI motility, and reduced constipation
32
Know contraindications for oxybutynin (Ditropan)
Angle-closure glaucoma, GI/GU obstructions, Myasthenia gravis, active cardiac dysfunction
33
Know the onset of action for each type of insulin
Rapid Acting (Lispro)🡪 15 min Short-Acting (Regular) 🡪 30-60 min Intermediate (NPH)🡪 1-2 hrs Long-acting (Lantus) 🡪 1-2 hrs
34
Review drug interactions with insulin and other drugs (HINT: think insulin and corticosteroid drugs)
Corticosteroids cause hyperglycemia
35
Know AE’s of metformin (Glucophage)
``` *Lactic acidosis→ Hyperventilation, cold, clammy, mm weakness, pain, malaise, dizziness, palpitations GI upset (super common) Vitamin B12 deficiency (long-term use). ```
36
Review proper storage, handling, and administration techniques of insulin
If stored in the refrigerator🡪 they are good until the expiration date on the vial If stored at room temp🡪 they are good for 1 month Clear before cloudy roll vials don’t shake
37
Know when to administer glucagon (GlucaGen)
Nonresponsive hypoglycemic pts
38
Review patient teaching for levothyroxine (Synthroid)
Take in AM on empty stomach, take 30 min-1H before breakfast Brand name vs generic matters Therapeutic effects may take up to 6 weeks** Monitor for hyperthyroidism
39
Know which labs to monitor for the patient taking propylthiouracil (PTU)
TSH, T3, T4 Monitor CBC and s/s of agranulocytosis *LFTs
40
Review the therapeutic onset for levothyroxine (Synthroid)
6 Weeks
41
Review drug interactions for fludrocortisone
Non-potassium-sparing diuretics (hypocalcemia and hypokalemia) Aspirin (added GI effects, increased risk for PUD) Antidiabetic drugs (reduce hypoglycemia effects, leading to elevated blood glucose) Rifampin and phenobarbital-decreased effectiveness
42
Know nursing considerations for corticosteroid drugs (HINT: think blood glucose levels)
Check blood glucose levels often
43
Identify contraindications for fludrocortisone
Don’t abruptly stop Heart Failure Hypersensitivity
44
Know what labs to monitor for a patient taking epoetin alfa (Epogen)
Hmgb (Men 14-17; Women 12-16) Needs to be less than 10 in cancer patients Hct (Men 41%- 50%; Women 36%-48%) erythropoietin level
45
Review patient teaching for ferrous sulfate (Feosol)
``` PO - spread doses across waking hours - give on EMPTY stomach - take with citrus/Vit C to help with absorption Oral - through straw to not stain teeth - rinse mouth after taking - dilute it ```
46
Identify which labs to monitor for a patient taking vitamin B12 (cyanocobalamin)
K+
47
Know contraindications for epoetin alfa (Epogen)
``` Uncontrolled HTN some malignancies (↑ cancer cells accidentally) iron deficiency anemia ```
48
Review the patient teaching for methotrexate (Trexall)
Bone marrow suppression | Can cause n/v
49
Know contraindications for etanercept (Enbrel)
Do not give to patients with active infection | Avoid giving live vaccines to patients taking this drug
50
Know patient teaching for etanercept (Enbrel)
Report s/s of infection immediately No live vaccines onset→ 1-2 weeks
51
Know interacting medications with enteral nutrition
Antibiotics, corticosteroids, phenytoin | ➢ Hold tube feeding for 2 hours before and after administering the drug
52
Understand nursing interventions with parenteral nutrition
Watch for fluid overload Hyperglycemia - Polyuria, polydipsia, polyphagia, HA, N/V Accuchecks D/C abruptly = rebound hypoglycemia = D5/D10
53
Know adverse effects of PPN, TPN, and enteral nutrition
PPN🡪 phlebitis, risk for fluid overload TPN🡪 infection, hyperglycemia Enteral: GI intolerance, aspiration pneumonia risk, dumping syndrome
54
Know contraindications for conjugated equine estrogen (Premarin) and Fosamax
Premarin: Estrogen dependent cancers, undiagnosed abnormal vaginal bleeding, pregnancy, active or hx of thromboembolic disorders, smoking Fosamax: Esophageal dysfunction, difficulty swallowing, serious kidney impairment, hypocalcemia, inability to sit or stand 30 min after administration **
55
Understand priority nursing assessment and monitoring with the use of oxytocin
Careful monitoring because it can cause uterine hyperstimulation syndrome which can lead to a uterine rupture Turn on side and administer oxygen, stop infusion Assess and document BP, HR, & RR of mother, as well as continuous fetal monitoring
56
Understand priority nursing interventions with Flomax
Can cause hypotension, monitor BP, advise client to do slow position changes Hold before eye surgery Teach life-long therapy Once daily at same time, 30 min after same meal***
57
Know drug interactions with Viagra
Nitrates and grapefruit juice
58
Understand patient education with testosterone in the topical gel form
To be applied to upper arms and shoulders at the same time each morning Avoid showering, bathing or swimming for 2 hours Watch out for skin-to-skin transfer
59
Know how to dose/administer other medications with Carafate
Causes physical interference with absorption of other drugs = take other drugs at least 2 hours ahead** Give 4x daily- 1 hr before usual three meals, and again at bedtime ** Take on empty stomach Use with caution with renal failure/dysfunction No antacids within 30 min of administration
60
Know patient education with proton pump inhibitors
Take 30-60 min in morning, on empty stomach, once daily dosing (before breakfast) May take a few days to relieve symptoms (not to be used for immediate relief) Long term therapy can cause osteoporosis Need to have routine bone density screening Increase calcium and Vit D Perform WBing exercises Limit drug therapy to lowest dose and shortest duration possible, recommended taking up to 8 weeks
61
Know adverse effects of each antacid
Aluminum hydroxide🡪 constipation + decreased phosphate Magnesium hydroxide🡪 diarrhea, caution c kidney failure Calcium carbonate🡪 constipation, caution c kidney failure
62
Know the timing of BM after taking laxatives (know for each type of laxative)
Psyllium🡪 soft, formed stool 1-3 days after beginning therapy, not a quick fix Docusate sodium🡪 stools will be softer 1-3 days after beginning therapy Bisacodyl🡪 bowel movement will come 6-12 hours after beginning therapy, 15-60 min c suppository
63
Understand patient education with Metamucil
Drink 8oz of fluid with each dose** | Taking before meals may reduce appetite
64
Know contraindications for use of laxatives
Esophageal or GI obstructions, fecal impaction, dysphagia, N/V, undiagnosed abdominal pain
65
Know adverse effects for Zofran
HA Dizziness Diarrhea
66
Understand patient teaching in regards to Scop Transderm patch
Anticholinergic effects→ cant see, pee, spit, shit: monitor Use gloves to administer and take off d/c after 72 hours recommend applying 4 hrs prior to anticipated N/V

Pharm 2 (2 decks)

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