Pharmacology Exam 3 Flashcards
(201 cards)
1
Q
When monitoring a patient who is taking a systemically administered glucocorticoid, the nurse should monitor for signs of:
A
Hypokalemia
2
Q
A patient is receiving aminoglutethimide (Cytadren) therapy. The nurse knows that this medication is used for which condition?
A
Cushing’s Syndrome
3
Q
A patient is taking fludrocortisone for Addison’s disease, and his wife is concerned about all the problems that may occur with his therapy. When teaching them about therapy with this drug, the nurse should include which information?
A
It should be taken with food or milk to minimize GI upset
4
Q
A patient is concerned about the body changes that have resulted from long-term prednisone therapy for the treatment of lupus erythematosus. Which of the following effects of this drug therapy would be present to support the nursing diagnosis of disturbed body image?
A
Weight gain
5
Q
When starting drug therapy with corticosteroids, the nurse is aware that some drugs can have adverse interactions with corticosteroids, such as:
A
NSAIDs
6
Q
The nurse is administering lispro insulin, and should keep in mind that this insulin is:
A
a rapid-acting insulin
7
Q
When teaching about hypoglycemia, the nurse should make sure that the patient is aware of the early signs of hypoglycemia, which are:
A
irritability and confusion
8
Q
The nurse is teaching a group of patients about self-administration of insulin. What teaching is important to include?
A
when mixing insulins, the clear (such as Regular) insulin should be drawn up into the syringe first
9
Q
A patient who has type II diabetes is scheduled for a laparoscopy and has been NPO since midnight. She is concerned about her medications being held. What is the best action regarding the administration of her oral anti diabetic drug?
A
contact the Physician for further orders
10
Q
When taking a rapid-acting insulin such as insulin aspart, which of the following is correct regarding administration?
A
It should be taken within 15 minutes of beginning a meal
11
Q
A patient has been prescribed warfarin (Coumadin) in addition to a heparin infusion. The nurse recognizes that the reason for the two anticoagulants is which of the following?
A
Heparin is often used to initiate therapy when oral anticoagulants are prescribed until laboratory tests indicate an adequate therapeutic response
12
Q
During thrombolytic therapy, the nurse monitors the patient for adverse effects. What is the most frequent undesirable effect of thrombolytic therapy?
A
Internal and superficial bleeding
13
Q
A patient has received too much warfarin. The nurse would expect to give which antidote for wafarin toxicity?
A
Vitamin K
14
Q
Which of the following is true for the patient receiving long-term aspirin therapy?
A
Laboratory studies should be done to monitor liver, renal, and clotting functions
15
Q
A patient is receiving an intravenous infusion of heparin. Which of the following laboratory studies will be used to adjust and monitor the dose of heparin?
A
aPTT (activated partial thromboplastin time)
16
Q
A patient arrives in the emergency department with sever chest pain. She says she has had pain off and on for a week now. Which assessment finding would indicate the need for cautious use of nitrates and nitrites?
A
Blood Pressure of 98/68 mm Hg
17
Q
A calcium channel blocker (CCB) is prescribed for patient , and the nurse provides instructions to the patient about the medication. What does the nurse tell the patient?
A
A high-fiber diet with plenty of fluids will help prevent the constipation that may occur
18
Q
A patient about to receive his morning does of digoxin has an apical pulse of 70 bpm. What will the nurse do?
A
Administer the dose
19
Q
A patient has been taking digoxin at home but has taken an accidental overdose and has developed toxicity. He has been admitted to the telemetry unit where the physician has ordered digoxin immune Fad (Digibind). The patient asks the nurse why the medication is ordered. What us the nurse’s best response?
A
“This drug is an antidote to digoxin and will help to lower the blood levels.”
20
Q
While assessing a patient who is taking a beta-blocker for angina, the nurse knows to monitor for which adverse effect?
A
Bradycardia (under 60 bpm)
21
Q
Break down clots
A
Thrombolytic Drugs
22
Q
activate plasminogen & convert it to plasmin, which can digest fibrin
A
Thrombolytic Drugs
23
Q
alteplase (Activase)
A
Thrombolytic Drug
24
Q
an enzyme that naturally occurs in the blood stream
A
alteplase (Activase)
25
"t-PA"
alteplase (Activase)
26
Half life of alteplase (Activase)
5 minutes --> constant infusion
27
main treatment of alteplase (Activase)
*stroke*
| acute MI, pulmonary embolism, acute ischemic stroke, clogged arterial lines [Cathflo-Activase]
28
2 Types of strokes
1. Clot
| 2. Blow out of blood vessel
29
streptokinase (Streptase)
Thrombolytic Drug
30
produced from beta-hemolytic strep
streptokinase (Streptase)
31
main treatment of streptokinase (Streptase)
*DVT*
| acute MI, pulmonary embolism
32
Prevents platelet adhesion at the site of blood vessel injury
Anti-Platelets
33
Once injury occurs --> platelets change shape
Anti-Platelets
34
aspirin (Acetylsalicylic Acid)
Anti-Platelet
35
The most common dose of this drug is 81mg/day
aspirin (Acetylsalicylic Acid)
36
Long-term use of this drug requires monitoring of liver, renal, and clotting function
aspirin (Acetylsalicylic Acid)
37
DO NOT give this drug to children, it can result in Reyes Syndrome
aspirin (Acetylsalicylic Acid)
38
This drug has the following adverse effects:
GI Bleeding, Diarrhea, Flushing, Dizziness
(heart burn, bleeding)
aspirin (Acetylsalicylic Acid)
39
main treatment of aspirin (Acetylsalicylic Acid)
MI --> 81 mg/day
stroke --> 325 mg/day
(anti-inflammatory, analgesic, antipyretic)
40
clopidogrel (Plavix)
Anti-Platelet
41
This drug has the following adverse effects:
| chest pain, flulike symptoms, dyspepsia (heart burn), abdominal pain, epistaxis (nose bleeds), bleeding, chills
clopidogrel (Plavix)
42
main treatment for clopidogrel (Plavix)
- arthrosclerotic events (stiff joints) -->75 mg/day
- post stent replacement --> 300 mg/day
- stroke
- transient ischemic attack
- post MT (thrombi-prevention)
43
eptifibatide (Intergrillin)
Anti-Platelet Drug given IV
44
An Antiplatelet drug only given in an ICU setting
eptifibatide (Intergrillin)
45
When administering eptifibatide (Intergrillin) you must monitor:
heart monitor at all times
46
Main treatment for eptifibatide (Intergrillin)
unstable angina or cardiac catheterization lab
| MI
47
inhibits formation of clotting factors but not on a clot that has already formed
anticoagulants
48
Indications that an anticoagulant drug is needed:
- MI
- Unstable angina
- A-Fib (pooling in R atrium [sometimes in L])
- indwelling devices (heart valve)
- major ortho surgery (femur/hip fracture)
49
Heparin
Anticoagulant
50
Concentrations of this drug can vary from 10 units to 40,000 units
Heparin
51
Half life of Heparin
1 - 2 hours
52
Monitoring of aPTT or PTT is a must with this drug
Heparin
53
antidote of this drug is protomine sulfate
Heparin
54
warfarin (Coumadin)
Anticoagulant
55
this anti-coagulant is the most commonly prescribed
warfarin (Coumadin)
56
This anti-coagulant is only given PO
warfarin (Coumadin)
57
monitoring of PT and INR is a must with this drug
warfarin (Coumadin)
58
goal of Heparin is:
aPTT 1.5 - 2.5 times the normal value
59
aPTT normal times are:
30 - 40 seconds
60
PTT normal times are:
50 - 70 seconds
61
PT normal times:
11 - 13 seconds
62
INR (international normalized ratio):
2 - 3
63
Goal on warfarin (Coumadin)
INR = 3.5
64
Antidote of warfarin (Coumadin)
Vitamin K
65
enoxaparin (Lovenox)
Anticoagulant
66
aka: low molecular weight heparin (LMWH)
enoxaparin (Lovenox)
67
this drug is fractionated heparin --> the smaller fragments have higher a attraction (affinity)
enoxaparin (Lovenox)
68
a pt can go home on this fractionated form of heparin
enoxaparin (Lovenox)
69
enoxaparin (Lovenox) has a longer half-life than heparin does, why is this beneficial?
enoxaparin (Lovenox) has a more predictable anticoagulant response
70
Anticoagulants
Coagulation Modifier Drug
71
Antiplatelets
Coagulation Modifier Drug
72
Thrombolytic Drugs
Coagulation Modifier Drug
73
Baseline vitals will ________ on Coagulation Modifier Drug
decrease
| HR will increase
74
Platelet counts are important with this drug:
aspirin (Acetylsalicylic Acid)
75
During Assessment History of abnormal bleeding is important with which type of drugs?
Coagulation Modifier Drugs
76
Coagulation Modifier Drugs are what kind of medication
High Alert!
77
With high alert medications what 3 things should a nurse do with another nurse?
1. Check Medication
2. Check Calculation
3. Check Pump
78
What drug is involved in NOT aspirating before administration?
Heparin
79
What drug do you NOT massage into muscle after aspiration?
Heparin
80
While administering what drug do you NOT want to pinch the muscle?
Heparin
81
What should a nurse do after drawing up Heparin?
Change the needle
82
What type of needle should be used while administering Heparin?
High Gauge, Short Length
83
When on Coagulation Modifier Drugs a pt should have labs on:
a regular basis
84
Signs/Sympotms of bleeding (with not pain) may occur with these drugs:
Coagulation Modifier Drug
85
A pt must wear a Med Alert Bracelet when on these types of drugs
Coagulation Modifier Drug
86
A patient should not have foods high is Vitamin K if on these types of drugs
Coagulation Modifier Drug
87
vasopressin (Pitressin)
Posterior Pituitary Drug
88
vasopressin tannate means
vasopressin in peanut oil
89
```
this drug is stored in the fridge:
before administration nurse must -->
-put into warm water
-shake vigorously (brown speckled dots should appear)
-repeat until dots appear
```
vasopressin tannate
90
an advantage of this posterior pituitary drugs is it lasts 48 - 72 hours
vasopressin (Pitressin)
91
adverse effects of this drug are water intoxication and excessive vasoconstriction
vasopressin (Pitressin)
92
main treatment of vasopressin (Pitressin)
diabetes insipidus = pee & drink excessively
| CPR, Cardiac Arrest
93
this drug increases ADH activity, which promotes conservation of water, which reduces urine production
vasopressin (Pitressin)
94
desmopressin (DDAVP)
Posterior Pituitary Drug
95
Routes of desmopressin (DDAVP)
intranasal, IV, subq, PO
96
Advantage of desmopressin (DDAVP)
Painless route of intranasal
97
Disadvantage of desmopressin (DDAVP)
repeat dose every 8 - 12 hours
98
water intoxication leads to...
diluting electrolytes --> seize --> death
99
Drug-to-Drug interactions with desmopressin (DDAVP)
lithium
100
Preferred Drug for Diabetes Insipidus is...
desmopressin (DDAVP)
101
Drug used to treat primary nocturnal enuresis (bed wetting)
desmopressin (DDAVP)
102
ADH Activity
- promotes renal conservation of water
| - reduces urine output
103
coticotropin (Adrenocorticotropic Hormone) (ACTH)
Anterior Pituitary Drug
104
Diagnosis of adrenocortical insufficiency
Addison's Disease
105
Main treatment of coticotropin (Adrenocorticotropic Hormone) (ACTH)
Addison's Disease
| exacerbation of MS [helps with strength and muscle pain
106
Adverse effects of coticotropin (Adrenocorticotropic Hormone) (ACTH)
increased blood glucose
107
This drug stimulates the release of cortisol from the adrenal cortex
coticotropin (Adrenocorticotropic Hormone) (ACTH)
108
octreotide (Sandostatin)
Anterior Pituitary Drug
109
This drug inhibits growth hormone
octreotide (Sandostatin)
110
Main treatments for octreotide (Sandostatin)
acomegaly and giganticism
111
another word for hyperpituitarism
giganiticism
112
over secreting of the pituitary gland results in this
hyperpituitarism
113
when a tumor is on the pituitary gland ________ is most likely to happen
over secreting
114
An annoying side effect of ACE inhibitors that may be minimized by switching to an angiotensin receptor blocking drug includes
a dry, nonproductive cough
115
The following statement is said by a patient on __________________ drugs :
“I will include rest periods during the day to help me tolerate the fatigue my medicine may cause.”
Antihypertensive
116
The following statement is said by a patient on __________________ drugs :
“I will change my position slowly to prevent feeling dizzy.”
Antihypertensive
117
The following statement is said by a patient on __________________ drugs :
“I will not mow my lawn until I see how this medication makes me feel.”
Antihypertensive
118
_____________ medications need to be taken routinely in order to maintain a normotensive state and prevent occurrence of complications. Many patients do not adhere to this regimen because hypertension itself does not cause symptoms, whereas the medication can cause some untoward effects. Patient teaching is essential.
Antihypertensive
119
______________ prevent the breakdown of bradykinin, frequently causing a nonproductive cough. Angiotensin receptor blocking drugs do not block this breakdown, thus minimizing this annoying side effect.
ACE inhibitors
120
What would the nurse question if ordered concurrently with ACE inhibitors?
potassium
121
__________ block the conversion of angiotensin I to angiotensin II, thus also blocking the stimulus for aldosterone production. Aldosterone is responsible for potassium excretion—decreased aldosterone can result in increased serum potassium.
ACE inhibitors
122
The nurse would plan to administer which calcium channel blocking drug to a patient with cerebral arterial spasms following a subarachnoid hemorrhage?
nimodipine (Nimotop)
123
____________ crosses the blood-brain barrier and has a greater effect on the cerebral arteries than on other arteries in the body, thus it is indicated for the treatment of cerebral arterial spasm following subarachnoid hemorrhage.
nimodipine (Nimotop)
124
The nurse would question an order for a calcium channel blocking drug in a patient with which condition?
Hypotension
125
Which statement would be most appropriate during discharge teaching for a patient receiving transdermal clonidine (Catapres)?
“The patch should be applied to a nonhairy site, and abrupt withdrawal should be avoided.”
126
When explaining different medication regimens to treat hypertension during a community education program, it would be accurate to state that African Americans probably respond best to which combination of medications?
Diuretics and calcium channel blockers
127
Research has demonstrated that _____________ do not typically respond therapeutically to beta-blockers or ACE inhibitors. They respond better to diuretics and calcium channel blockers.
African Americans
128
Carvedilol (Coreg) is classified as a
Dual action alpha1 and beta-receptor blocker
129
____________ blocks both the alpha1 and beta-receptors of the adrenergic nervous system.
Carvedilol (Coreg)
130
Signs and symptoms of ___________ toxicity include extreme hypotension, abdominal pain, apprehension, diaphoresis, dizziness, muscle twitching, nausea, irregular pulse rates, vomiting, and pain behind the sternal area of the chest.
nitroprusside (Nipride)
131
The nurse would monitor for reflex tachycardia in a patient receiving which classification of antihypertensive drugs?
Direct-acting vasodilators
132
____________ decrease blood pressure but have no effect on myocardial conduction, thus allowing for reflex tachycardia.
Direct-acting vasodilators
133
_______ and _________ both have a negative chronotropic effect that negates the reflex tachycardia.
Calcium channel blockers and beta-blockers
134
A patient prescribed prazosin (Minipress) does not have a history of hypertension. The nurse would assess for what disorder for which this medication is also used?
Obstructive benign prostatic hyperplasia
135
ACE inhibitors and angiotensin receptor blockers both work to decrease blood pressure by
preventing aldosterone secretion.
136
ACE inhibitors block the formation of
angiotensin II
137
angiotensin receptor blockers allow the formation of __________ but block its effect at the receptors
angiotensin II
138
Which is a priority nursing diagnosis for a patient taking an antihypertensive medication?
Ineffective tissue perfusion related to disease process and/or medication
139
Patients taking ____________ medication are at risk for ineffective cerebral, renal, and cardiac perfusion.
antihypertensive
140
__________ has the dual antihypertensive effects of reducing heart rate (beta1 receptor blockade) and also vasodilation (alpha1-receptor blockade).
Carvedilol (Coreg)
141
Which is an expected outcome associated with the administration of digoxin?
Decreased heart rate
142
Therapeutic serum digoxin levels are
0.5 to 2 ng/mL
143
A patient is taking digoxin 0.25 mg and furosemide (Lasix) 40 mg. When the nurse enters the room, the patient states, “There are nice yellow halos around the lights.” Which action will the nurse take?
Evaluate the patient for other symptoms of digoxin toxicity
144
which drug results in the following therapeutic effects?
| Positive inotropic, negative chronotropic, and negative dromotropic
digoxin
145
Which effect(s) would alert the nurse to suspect early digitalis toxicity?
anorexia, nausea and vomiting (related to the gastrointestinal tract), fatigue, headache, depression, weakness, drowsiness, confusion, and nightmares
146
Phosphodiesterase inhibitors have an added advantage in treating heart failure because they cause a positive inotropic effect and
vasodilation
147
Assessment of a patient receiving a positive inotropic drug would include reviewing which values?
- lung sounds
- daily weights
- apical pulse
- serum electrolytes
148
The nurse would question the use of milrinone (Primacor) in a patient with which disorder?
Systolic heart failure
149
When teaching a patient regarding the administration of digoxin, the nurse instructs the patient not to take this medication with which food?
Wheat Bran
150
Which is an indication for use of the antidysrhythmic drug lidocaine?
Ventricular arrhythmias
151
When giving adenosine, it is important to remember to
give it as a fast intravenous push.
152
To prevent the occurrence of cinchonism in a patient prescribed quinidine, the nurse emphasizes the importance of
avoiding ingestion of antacids.
153
Adenosine is used to treat which condition?
Paroxysmal supraventricular tachycardia (PSVT)
154
Sodium channel blockers are considered which class of antiarrhythmic drugs?
Class I
155
Ibutilide (Corvert) is a class III antiarrhythmic drug that is used for
conversion of recent-onset atrial fibrillation and flutter.
156
Potential side effects from __________ include photosensitivity, bluish skin discoloration, hyperthyroidism, hypothyroidism, and decreased libido
amiodarone
157
Before administering a dose of an antiarrhythmic drug to an assigned patient, which assessments would be of highest priority?
Apical pulse and blood pressure
158
Which classification of drugs is used to treat both hypertension and dysrhythmias?
Calcium channel blockers
159
Calcium channel blockers have which pharmacodynamic effect?
Coronary vasodilation
160
Amiodarone toxicity is evidenced in which body system?
pulmonary
161
Which instruction should be included in the discharge teaching for a patient with a transdermal nitroglycerin patch?
“Apply the patch to a nonhairy, nonfatty area of the upper torso or arms.”
162
Nitrates relieve angina pain by reducing preload, which is
blood volume within the heart.
163
Common side effects of ________ include flushing, headache, and hypotension.
nitroglycerin
164
The following statement is said by a patient on __________________:
"I should keep my medication in a cool, dry place.”
nitroglycerin
165
Patients on this drug are taught to take up to three tablets 5 minutes apart. If no relief from chest pain is obtained after three tablets, they should seek medical assistance.
nitroglycerin
166
Calcium channel blockers reduce myocardial oxygen demand by reducing afterload, which is
pressure against which the heart must pump
167
Which nitrate preparation or dosage form has the longest duration of action?
Transdermal nitroglycerin patch
168
In order to prevent the development of tolerance, the nurse instructs the patient to perform which action?
Tolerance can be prevented by maintaining an 8- to 12-hour nitrate-free period each day.
169
Nitrates relieve angina pain by reducing afterload, which is:
pressure against which the heart must pump
170
During patient teaching, the nurse explains that nitroglycerin relieves chest pain primarily by which action?
Decreasing the workload of the heart
171
It is most important to instruct a patient prescribed nitroglycerin to avoid which substance(s)?
Erectile dysfunction medications
172
When caring for a patient with angina, the nurse would question an order for a noncardioselective beta-blocker in a patient with coexisting
bronchial asthma
173
Which laboratory value might indicate an adverse response to hydrochlorothiazide (HydroDIURIL)?
Glucose levels
174
When teaching a patient why spironolactone (Aldactone) and furosemide (Lasix) are prescribed together, the nurse’s statements are based on knowledge that
this combination promotes diuresis but decreases the risk of hypokalemia.
175
Which laboratory value depicts a known side effect of furosemide (Lasix)?
Hypokalemia
176
A patient is admitted to the hospital with pneumonia and has a history of chronic renal insufficiency. The physician orders furosemide (Lasix) 40 mg twice a day because it
is effective in treating patients with renal insufficiency
177
A patient taking spironolactone (Aldactone) requests assistance with dietary choices. The nurse would NOT recommend which food choices?
bananas
178
This drug is used to treat high-altitude sickness, edema secondary to heart failure, and open-angle glaucoma
Acetazolamide (Diamox)
179
When preparing to administer furosemide (Lasix) intravenously to a patient with renal dysfunction, the nurse plans implementation based on knowledge that the medication should be administered no faster than which rate?
4 mg/min
180
Hyperkalemia, dizziness, and headache are common side effects associated with
potassium-sparing diuretics
181
A patient asks about taking potassium supplements while taking spironolactone (Aldactone). What is the nurse’s best response?
"You are on a diuretic that is potassium-sparing, so there is no need for extra potassium.”
182
the direct antagonist for aldosterone
spironolactone (Aldactone)
183
The nurse prepares to administer which diuretic to treat a patient suffering from acute pulmonary edema?
furosemide (Lasix)
184
an osmotic diuretic that pulls fluid from extravascular spaces into the bloodstream to be excreted in urine. This will decrease intracranial pressure, increase excretion of medications, decrease urine osmolality, and increase serum osmolality.
mannitol
185
When assessing a patient on triamterene (Dyrenium), the nurse would specifically monitor for which adverse effect?
Hyperkalemia
186
When teaching a patient about signs and symptoms of hypokalemia, the nurse will instruct the patient to notify the health care provider if which occurs?
Leg cramps
187
The nurse would question the health care provider if which type of diuretics is prescribed to a patient with gout?
Thiazide diuretics --> can cause hyperuricemia
188
A patient with severe trauma is admitted to the intensive care unit. The patient has received 5000 mL of normal saline, is exhibiting peripheral edema, and remains hypotensive. The nurse anticipates administering which substance to correct fluid balance?
hetastarch (Hespan)
189
When caring for a patient with serum potassium of 2.8 mEq/L, which is a priority nursing intervention when administering intravenous replacement therapy?
Maintain infusion rate at no greater than 20 mEq/hour
190
When planning administration of hypertonic saline solution to treat a patient with severe hyponatremia, the nurse monitors for signs and symptoms of overdose as manifested by
flushed skin and increased thirst.
191
A patient receiving a unit of red blood cells suddenly develops shortness of breath, chills, and fever. Following patient assessment, the nurse’s initial action should be to
discontinue the infusion of packed cells
192
The nurse is caring for a patient with an acute renal insufficiency and thrombocytopenia. Along with platelet transfusions, the nurse would expect to administer which substance to increase deficient clotting factors in this patient?
Fresh frozen plasma
193
The nurse would assess which laboratory value to determine the effectiveness of intravenous heparin?
Activated partial thromboplastin time (aPTT)
194
A patient who has been anticoagulated with warfarin (Coumadin) is admitted with gastrointestinal bleeding. The nurse will anticipate administering which substance?
vitamin K
195
The nurse understands that a patient’s international normalized ratio (INR) value of 2.5 means that
the patient’s warfarin dose is therapeutic
196
Enoxaparin sodium (Lovenox) is an anticoagulant used to prevent and treat deep vein thrombosis and pulmonary embolism. This drug is in which drug group?
Low molecular weight heparin
197
The patient asks what the difference is between dalteparin (Fragmin) and heparin. What is the nurse’s best response?
“Dalteparin is a low molecular weight heparin that has a more predictable anticoagulant effect.”
198
Before emergency surgery, the nurse would anticipate administering which medication to a patient receiving heparin?
protamine sulfate
199
A patient is started on oral anticoagulant therapy while still receiving intravenous heparin. The patient is concerned about risk for bleeding. What is the nurse’s best response?
“It usually takes 4 to 5 days to achieve a full therapeutic effect for warfarin, so the heparin is continued to help prevent blood clots until the warfarin is working up to speed.”
200
Before administering alteplase (Activase), it is important for the nurse to perform which action?
Perform all necessary venipunctures
201
The nurse recognizes that patient teaching regarding warfarin (Coumadin) has been successful when the patient acknowledges an increased risk of bleeding with concurrent use of which herbal products?
Garlic, Ginkgo, Ginseng
