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Do drugs act by creating new functions or by modifying existing functions in the body?
How do opium drugs enter the cell?
opioid receptors in the brain bind with opiate drugs to produce analgesia
A drug absorbed from the lining of the mouth enters portal circulation or systemic circulation first?
systemic circulation through capillaries in the mouth
Hives are defined as what type of drug side effect?
drug allergy (mild genetic/immune reaction)
What route delivers drugs most rapidly?
What is the difference between the routes orally (PO) and sublingually (SL)?
- a) Orally= stomach → small intestine → liver → heart → systemic circulation
- b) Sublingually = capillaries in mouth → systemic circulation
Why do older adults have less ability of drugs to bind to albumin?
have low albumin levels from malnourishment, reduced renal function and changes in ratios of body water, body fat and lean muscle mass influence distribution and excretion of drugs
What drug dosage must be checked by two nurses?
All insulin, heparin, and parenteral pediatric meds
What should the client be taught regarding making up a missed dose of a prescribed med?
To not double up the missed dose, but to take the missed dose as soon as remembered unless within 2 hours of next scheduled dose. Report to the M.D. if two doses missed
What are three causes of noncompliance with prescribed meds?
- a) misunderstanding of the instructions
- b) unable to get prescription filled
- c) intolerable side effects
What should be assessed when a client is taking a GI stimulant?
- a) check bowel sounds, note when they return to usual pattern
- b) check that barium is expelled following GI studies
What is the desired action of atropine on the GI tract ?
decreased GI motility and secretions by blocking the parasympathetic nervous system
What type laxative is docusate?
wetting agent → takes 1-2 days for effect → used to reduce straining
When stimulant laxatives are abused, what untoward situations can occur?
dehydration and electrolyte imbalance
What effect does the laxative, lactulose, have on ammonia?
lowers blood ammonia that is present with liver failure. lactulose prevents protein absorption in intestine
What action do opioids have in the treatment of diarrhea?
How does marijuana act to prevent vomiting?
depresses chemo-receptor trigger zone
What is the action of antacids?
neutralize hydrochloric acid
Which type antacid causes diarrhea? Which type causes constipation?
- a) magnesium → diarrhea
- b) aluminum and calcium → constipation
How should an antibiotic prescription be taken?
What is the definition of super-infection?
Infections that arises during antibiotic treatment. They involve organisms that are resistant to the antibiotic originally used. Broad spectrum antibiotics eliminate normal body flora that control normally resistant pathogens
What is the action on an organism of sulfonamides?
bacteriostatic--blocks bacterial synthesis of folic acid
What is the definition of antibiotic resistance, and what causes antibiotic resistance to develop?
- a) organism adapts so that drug therapy is no longer effective
- b) inherited→ stable genetic trait
- c) acquired→ mutation
- d) plasmid→ DNA pieces separated from bacterial chromosome
What is the action on an organism of an aminoglycoside?
bacteriocidal--inhibits bacterial protein synthesis and affects the cell membrane
What are the two major side effects of aminoglycoside?
- a) nephrotoxic →monitor renal function, check serum BUN and creatinine
- b) ototoxic (loss of equilibrium and hearing) → monitor auditory functioning during therapy; check balance and for report of buzzing
What major side effects does oral tetracycline cause?
- a) Children: causes newly formed permanent teeth to be stained and slows bone growth
- b) Adults: darkens the tongue
What is the correct way to take nystatin oral suspension?
hold in mouth then swish, gargle, and then swallow
Why should the blood level of an antibiotic trough level be obtained?
To check serum levels before a dose is due b/c it reflects the lowest serum level.
What nursing action best prevents the development of drug resistance in clients with tuberculosis?
Directly Observed Therapy (DOT)
What two meds (either may be used) for initial treatment of moderate hypertension?
diuretic or beta blocker
Metoprolol (Lopressor) is which type of adrenergic inhibitor?
Beta blocker, its action: block receptors at vessel level; decrease oxygen requirement of the myocardium
What are three side effects of beta-blockers: propranolol (Inderal) and nadolol (Corgard)?
bradycardia, depression, and impotence
What type antihypertensive is lisinopril (Zestril)?
ACE inhibitor its action: blocks the enzyme that converts renin to angiotensin. Renin is a hormone secreted by the kidney that increases BP
What foods are high in potassium that the client taking a loop diuretic or thiazide diuretic should eat?
bananas, citrus juice, meats, and nuts
What major side effect is caused by all meds that lower B/P? What are clients instructed to do to lessen this side effect?
- a) Cause dizziness from orthostatic hypertension.
- b) Arise slowly from lying to standing; avoid sudden strenuous exercise (pulse cannot adapt), hot baths (vasodilates), motionless and dependent legs (blood pools).
How should nitroglycerin patch be applied?
place on a dry, hairless area away from monitoring and defibrillation sites; rotate application sites
State the steps to correctly use nitroglycerin aerosol?
- a) do not shake the container
- b) hold upright
- c) close mouth around mouth piece
- d) activate spray
- e) do not swallow for 1-2 mins
How frequently can nitroglycerin (NTG) tablets be taken? When should a client go to an emergency facility?
May repeat a total of three doses taken at 5 min intervals, if no relief after third dose, call EMS/go to Emergency Dept
What does streptokinase do to a clot?
(fibrinolytic agent) dissolves clots
What vision changes indicate digoxin toxicity?
yellow vision: pt report of seeing yellow halos around objects
What effect does warfarin (Coumadin) or heparin, anticoagulants have on a clot?
Prevents clotting does not breakdown the clot
How will spontaneous bleeding, a side effect of anticoagulants, be seen?
- a) hematuria, epistaxis, bleeding gums
- b) oozing venipuncture sites
- c) black, tarry stools
- d) coffee ground vomitus
What is the antidote to warfarin (Coumadin)? To heparin?
- a) Coumadin → Vitamin K
- b) heparin → protamine sulfate
What blood test is used to monitor warfarin (Coumadin)? To monitor heparin?
- a) warfarin (Coumadin) = INR & PT
- b) heparin = PTT
What is the life-threatening side effect of heparin?
What over the counter drugs should the client not take while on anticoagulants?
multivitamins high in vitamin K, aspirin, or salicylates (Alka-Seltzer, BC/Goody's powder, Bufferin, Excedrin, Midol)
What med is prescribed for pernicious anemia? How is it given? How often?
Vitamin B12 administered IM daily for one week then monthly throughout lifetime or nasal spray once a week at least one hour before or after ingestion of foods or liquids
What effect does folic acid have on red blood cells?
promotes RBC (maturation) development
What is the action of antihemophilic factor? How is it given?
helps to clot blood, given IV
What activities should the client not do if taking the antihistamine Benadryl?
Should not drive, operate machinery. Older pts should be supervised while ambulating.
What are the side effects of chlor-trimeton?
- a) drowsiness
- b) sedation
- c) blurred vision
- d) tachycardia
What does an Anti-Tussive medication alleviate?
List the sequence of steps for using a multi-dose inhaler?
- a) Use spacer device to keep inhaler 1 1/2 inches away from the mouth
- b) Seal mouth on mouthpiece
- c) Breathe deeply once
- d) Activate the inhaler
- e) Continue breathing in for 5 seconds
- f) Hold breath min of 10 seconds
- g) Breathe out slowly (pursed lips)
- h) Wait 2 mins between doses
What is the drug, beclomethasone inhaler, used for?
Prevents bronchoconstriction (inhibits mast cells, reduce airway responsiveness)
What meds block leukotrienes and prevent inflammation?
- a) montelukast (Singulair)
- b) zafirlukast (Accolate)
What is the therapeutic theophylline serum level so that a time released theophylline capsule can be given?
Surfactant is given to prevent what occurrence in the lungs?
collapse of alveoli
What are the causes of hyperfunction of glands, which requires that drugs to block hormone production be given?
- a) benign hyperplasia
- b) congenital overproduction
- c) nonendocrine tumor
- d) excessive hormone replacement therapy (HRT)
What is the action of the thyroid replacement drug, Synthroid (levothyroxine)?
replaces T4 (regulate body metabolism, oxygen consumption and heat production)
Liotrix is a combination of what two hormones?
T3 & T4
What are the toxic side effects of Tapazole and Propacil?
sore throat, fever, rash, leukopenia (monitor CBC)
What replacement hormone drug is used to treat hypothyroidism?
- a) levothyroxine (Synthroid) is T4
- b) liothyronine (Cytomel) is T3
- c) Liotrix is combined T3 & T4
What is the action of Sandostatin when given for hyperfunction of the anterior pituitary?
suppresses growth hormone, given SQ
What is the action of Glucotrol?
lowers blood glucose by directly stimulating beta cells to secrete insulin
What is the action of Micronase?
increase the insulin cell receptor responsiveness
What is the action of Precose?
Slows digestion of complex CHO
What does insulin onset mean?
how many minutes after receiving the insulin, it begins lowering the blood glucose
During the peak of a dose of insulin, the patient should be monitored for possible occurrence of what situation?
What is the onset, peak, and duration time for N Humulin?
- a) Onset: 60 min
- b) Peak: 8 h
- c) Duration: 24 h
What signs will a patient display if experiencing hypoglycemia? Hyperglycemia?
a) Hypoglycemia S/S: headache, dizziness, difficulty problem solving, restlessness, hunger, tachycardia, cold & clammy skin, sweating, decreasing LOC, seizure, coma
b) Hyperglycemia S/S: fatigue, polyuria, polydipsia, Kussmaul respirations (deep, blowing respirations), abdomen cramps, flushed face, blurred vision, rapid, thready pulse
What action does anticholinergic eye drops have on the eyes?
Which eye drops are a carbonic anhydrase inhibitor?
- a) acetazolamide (Diamox)
- b) dorzolamide (Trusopt)
- c) Action: Decreases formation of aqueous humor
- d) Side effects: weak diuretic effect, headache, tingling sensation
What are the side effects of lanoprost (Xalatan) eye drops?
brown pigment in iris and changes in eye color
List the steps for administering eye drops. Which should be given first, eye drops or ointments? When two are used how long a period should there be between applications?
- a) wash hands
- b) place in lower conjunctival sac
- c) occlude the nasolacrimal duct for 1 minute
- d) wash hands
- e) wait 3 minutes between application
- f) Note: give drops before ointment and glucocorticosteroid first
What is the major neurotransmitter of the sympathetic nervous system?
Catecholamines: epinephrine, norepinephrine, dopamine
What major behavioral characteristic of patients with depression must constantly be monitored and prevented even when anti-depressant meds are given?
thoughts of suicide
Thorazine is prescribed for what neurological disorders?
Which hypnotic drug causes less paradoxical excitement?
What drug is used to control the mania of bipolar disorder?
When taking the MAOI, Nardil, what should the patient not drink?
anything high in tyramine such as wine
Alcohol has what effect on the central nervous system?
CNS depressant-- sedation, disinhibition, anesthesia
What is the action of the drug: carbidopa (Sinemet)?
- a) anti-Parkinson agents: converts to dopamine in the brain
- b) side effects: orthohypotension
A patient should be instructed to take tacrine (Cognex) at what time of the day?
- a) take at bedtime once a day
- b) drug is an acetylcholinesterase inhibitor along with donepezil (Aricept)
State the action of interferon-b (Betaseron) and describe how and when it is administered to a patient with Multiple Sclerosis?
given IM every other day to suppress immune response and reduce spasticity
List the objective indicators of pain.
- a) increased pulse and respiration
- b) elevation in B/P
- c) perspiration
- d) dilation of pupils
- e) crying, grimacing, and restlessness
What neurotransmitter controls pain, fever, and inflammation?
prostaglandin E2, an eicosanoid
What is the action of allopurinol (Zyloprim)?
inhibits formation of uric acid crystals and prevents gout attacks by keeping urine alkaline
Opioids affect what neurotransmitter?
mimics beta-endorphin → raises threshold for pain perception, reduces anxiety and induces sleep
For what types of pain are opioids used?
moderate to severe pain associated with trauma, surgery, heart attack, biliary or ureteral pain, inflammation, and cancer
What are the side effects of the opioids: Demerol and Dilaudid?
- a) constipation
- b) urinary retention
- c) hypotension
- d) pinpoint pupils
What drug is utilized to displace opioids from receptors in opioid overdose?
What can the patient not do after receiving curare?
cannot move--neuromuscular blocking drug produces muscle relaxation by preventing muscular contraction
What is the most commonly used inhalation anesthetic?
Isoflurane (Forane), usually given via endotracheal intubation
When should an anti-emetic be administered for a patient who is to receive chemotherapy?
30 mins before
What is the category and side effects of Cisplatin?
- a) alkalating agent (alters DNA structure) b) cell cycle non-specific
- c) toxicity: renal damage (check creatinine), hearing loss (admin. hearing acuity test), and alopecia
When taking Capecitabine (Xeloda), what factors may initiate or worsen the side effects of Hand and Foot syndrome?
- a) heat and pressure → adjust dose and give NSAIDS
- b) Note: take with food, drink 2000-3000 ml fluid daily
What cell activity is occurring during the M phase?
Mitosis cell division occurs
What type of antibiotic is used to treat a patient with respiratory anthrax?
What colony-stimulating factor stimulates the production of platelets? Of WBCs? Of RBCs?
- a) platelets = Neumega
- b) WBC = Neupogen
- c) RBC = Epogen
What medication is considered an unconventional cancer treatment?
laetrile (amygdalin) considered dangerous