Test III (Pharm)

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Test III (Pharm)
2015-10-24 17:32:55

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  1. What are the first line therapies for allergic rhinitis
    • glucocorticoids (beclomethasone)
    • antihistamines (azelastine; loratadine)
    • sympathomimetics (in conjunction to relieve congestion)
  2. What are adverse effects of inhaled glucocorticoids?
    • drying of nasal mucosa
    • burning or itching sensation
    • sore throat
    • epistaxis
    • headache
    • adrenal suppression (rare)
    • slowing of linear growth in children (rare)
  3. How long does inhaled glucocorticoids take effect?
    • seasonal: week or more
    • perennial: 2-3 weeks
  4. Oral antihistamines are most effective when taken when?
    • prophylactically
    • admin on regular basis even when symptoms are absent during allergy season
  5. What are the two intranasal antihistamines?
    • azelastine
    • olapatadine
  6. Intranasal cromolyn is most effective when given when?
    • Prophylactically; before symptoms present
    • may take 1-2 weeks for responses
  7. Examples of sympathomimetics? MOA? Admin?
    • phenylephrine (intranasal/oral)
    • ephedrine (PO)
    • pseudoephedrine (PO)
    • they activate alpha1 adrenergic receptors --> vasoconstriction
  8. AE of phenylephrine/pseudoephedrine?
    • rebound congestion
    • CNS stimulation (irritability, anxiety, restlessness, insomnia)
    • cardiac (systemic vasoconstriction)
    • abuse (ephedrine & pseudoephedrine)
  9. How to reduce rebound congestion caused by phenylephrine/pseudoephedrine
    • limit use for 3-5 days only
    • often occurs w/ topical agents
    • d/c med one nostril at a time
  10. Diff bet topical and oral sympathomimetics?
    • Topical more effective, works faster, more rebound congestion
    • oral: more systemic effects (vasocontstiction, CNS stimulation)
  11. Which 2 sympathomimetics are used for abuse? prevention?
    • ephedrine and pseudoephedrine
    • thay have similar effects w/ amphetamine
    • placed behind counter w/ PX
  12. What other drugs are used for allergic rhinitis? (3)
    • Atrovent (anticholinergic): reduce secretions
    • singulair (leukotriene antagonist):relieve nasal congestion
    • xolair-omalizumab (antibody): off-label use
  13. SE of montelukast (singulair)?
    • neuropsych effects
    • agitation, aggression, hallucinations, depression, insomnia, restlessness, suicidal thinking
  14. 2 major groups of antitussives?
    • opioid (codeine; hydrocodone)
    • nonopioid (dextromethorphan; diphenhydramine; benzonatate)
  15. benzonatate MOA; how to take?
    • decrease sensitivity of respiratory tract stretch receptors
    • need to be swallowed intact d/t risk of bronchospasm, laryngospasm, circulatory collapse
  16. combination cold remedies usually include:
    • decongestant
    • antitussive
    • analgesic
    • antihistamine (to decrease secretion)
    • caffeine (offset sedative effects)
  17. OTC cold remedies should not be used by:
    children younger than 2 years old
  18. Which instruction by the nurse should be the priority for a patient scheduled to start intranasal cromolyn [NasalCrom]
    relief may take a week or two
  19. Which instruction should the nurse include in the teaching for a patient prescribed cetirizine [Zyrtec] for seasonal allergic rhinitis?
    "Take the medication daily throughout the allergy season.
  20. Which class of drugs is most effective in preventing and treating seasonal and allergic rhinitis?
    intranasal glucocorticoids
  21. Which instruction should be included in the teaching for a patient being started on the antihistamine azelastine [Astelin]
    You may experience an unpleasant taste in your mouth when using azelastine."
  22. Goals of treatment of TB
    • eliminate symptoms
    • prevent relapse
  23. Sputum cultures of TB takes how many weeks? faster way?
    • 2-3 weeks
    • NAA nucleic acid amplification
  24. The principal cause of emergence of resistance in TB is
    inadequate drug therapy
  25. Rule in TB therapy; rationale
    • must always contain two or more drugs
    • decr risk of resistance and relapse
  26. 2 phases of TB therapy
    • initial phase (induction) -eliminate actively dividing tubercle
    • second phase (continuation) eliminate persisters
  27. Patients with HIV cannot take which TB med? why?
    • Rifampin; because it speeds up metabolism of antiviral drugs
    • can replace w/ rifabutin
  28. 2 tests for latent TB
    • TB skin test
    • IGRA (interferon gamma release assay)
  29. Treatment of latent TB
    • isoniazid daily for 9 months
    • isoniazid + rifapentine weekly for 3 months
  30. First line drugs for TB
    • isoniazid
    • rifampin
    • rifapentine
    • rifabutin
    • pyrazinamide
    • ethambutol
  31. AE of isoniazid
    • hepatotoxicity
    • peripheral neuropathy
  32. Admin of isoniazid
    take on empty stomach
  33. Isoniazid can raise levels of which drug? s/s?
    • phenytoin
    • ataxia, incoordination
  34. Besides TB, rifampin is also used for? 4
    • leprosy
    • meningitis
    • influenza
    • staph
  35. AE of rifampin (2)
    • hepatotoxicity
    • red-orange color urine, sweat, saliva, tears
  36. Rifampin can decrease effectiveness of which meds? (3)
    • contraceptives
    • warfarin
    • HIV meds
  37. AE of pyrazinamide? (2)
    • hepatotoxicity
    • nongouty polyarthralgias
  38. AE of ethambutol? (1)
    • optic neuritis: blurred vision, reduced color discrimination
    • not recommended for children < 8
  39. Which med is used instead of ethambutol for children?
    PAS (para-aminosalicylic acid)
  40. The injectable drugs used for TB can cause? 2
    • renal damage
    • 8th nerve damage
  41. Cycloserine AE? level?
    • CNS effects ( anxiety, depression, confusion..)
    • 25-35 mcg/ml
  42. Bedaquiline is used for? AE?
    • multidrug-resistant TB
    • prolonged QT interval
  43. MB leprocy tx regimen?
    • Rifampin
    • Dapsone
    • Clofazimine
    • for 12 months
  44. Single-lesion leprosy tx?
    • single dose ROM
    • rifampin, ofloxacin, minocycline
  45. Clofazimine SE?
    red color of feces, urine, sweat, tears
  46. A patient who has tuberculosis is treated with isoniazid. The nurse should monitor for which symptoms, which could indicate a vitamin B6 deficiency caused by the medication?
    Numbness and tingling in the fingers and toes
  47. What are the agents used to promote follicular maturation and/or ovulation?
    • clomiphene
    • menotropins
    • follitropins
    • hCG
  48. how is cervical mucus restored?
    ethinyl estradiol
  49. What is the mechanism of action of clomiphene?
    promote follicular maturation and ovulation by blocking estrogen receptors
  50. Before starting therapy with clomiphene, what two things need to be ruled out?
    • pregnancy
    • pituitary and ovarian fn intact
  51. What is the admin schedule of clomiphene?
    • during menses, start 5 days after
    • no menses, start anytime
  52. What is the most serious AE of menotropin?
    ovarian hyperstimulation syndrome
  53. Monitoring of menotropin therapy:
    US; estrogen level
  54. Menotropin consists of what?
    equal amounts of LH and FSH
  55. What is the AE of hCG?
    ovarian hyperstimulation syndrome
  56. hCG admin routes? w/ clomiphene? w/ menotropin/follitropin?
    • hCG (IM)
    • Choriogonadotropin (SQ)
    • 7-9 days after
    • 1 day after
  57. what is the pretreatment for hCG?
    menotropin, follitropin or clomiphene to induce follicular maturation
  58. Which medication is a dopamine agonist used to correct amenorrhea and infertility d/t high prolactin?
  59. Which of these instructions should a nurse give a patient who is to start taking clomiphene [Clomid]? "Have intercourse every other day for 5 to 10 days after the last dose of this medication."
  60. When evaluating the effects of leuprolide [Lupron] in a patient who has endometriosis, a nurse should monitor the laboratory results for which hormone or hormones?
    Follicle-stimulating hormone (FSH) and luteinizing hormone (LH)
  61. he nurse is aware that goserelin [Zoladex] has several uses, including which? (Select all that apply.)
    • Endometriosis Correct
    • Dysfunctional uterine bleeding Correct
    • Prostate cancer Correct
    • Breast cancer
  62. Prinicipal inidication for androgens?
  63. Hormone therapy has 3 indications
    • -mod to severe vasomotor symptoms
    • -mod to severe vulvar and vag atrophy
    • -prevention of osteoporosis
  64. Which 2 antidepressants are being used to treat hot flashes?
    • (escitalopram) Lexapro
    • (desvenlafaxine) Pristiq
  65. Admin of estrogen patch? cream? gel? spray? ring?
    • abdomen or trunk
    • top of both thighs or back of both calves
    • after showering, one arm from shoulder to wrist
    • inner forearm; dry for 2 minutes
    • into vagina
    • leave in place for 3 mos
  66. During the follicular phase of the menstrual cycle, estrogen has which effects on the female reproductive organs?
    Proliferation of the endometrium
  67. What is the primary difference between the selective estrogen receptor modulators tamoxifen and raloxifene?
    Raloxifene does not increase the risk for uterine cancer.
  68. Progestins may be used to treat which conditions?
    • Endometrial hyperplasia Correct
    • Dysfunctional uterine bleeding Correct
    • Endometriosis Correct
    • Breast cancer
    • Amenorrhea
  69. Which 2 progestins have the greatest risk for thrombosis?
    • drospirenone
    • desogestrel
  70. Risk factors that increase risk of thromboembolism: 3
    • smoking
    • hx of thromboembolism
    • hx of thrombophilias
  71. OCs should be DC'd when before surgery?
    4 weeks
  72. Which meds REDUCE the effects of OCs?
    • rifampin
    • ritonavir
    • antiSZ
    • St john's wort
  73. Which meds need be increased when used with OCs?
    • warfarin
    • oral hypoglycemics
  74. IUDs should only be used by who?
    monogamous women with low risk of STD
  75. Mifepristone (Mifeprex) is used for what?
    • abortion; it blocks receptors for progesterone and glucocorticoids
    • can be given within 7 wks of conception
  76. A patient who takes an angiotensin-converting enzyme (ACE) medication is scheduled to begin taking the Yaz oral contraceptive (OC). Which laboratory results should the nurse monitor during the first cycle of use?
  77. A nurse obtains a health history from a patient who is scheduled to take a combination OC. Which factor in the patient's history should the nurse recognize as a contraindication to this treatment?
    breast CA
  78. he nurse is aware that which 28-day regimen is least likely to simulate ovarian production of estrogens and progestins?
  79. What is the main diff between NRTIs and NNRTIs?
    • NNRTIs cause DIRECT inhibition of reverse transcriptase
    • given in active form
  80. Efavirenze (Sustiva) AE 4
    • CNS symptoms
    • rash
    • teratogenic
    • liver damage
  81. AEs of protease inhibitors (5)
    • hyperglycemia
    • fat redistribution (pseudo-Cushing's)
    • hyperlipidemia
    • increased bleeding
    • reduced bone mineral density
  82. Scultpra is used to
    restore or correct loss of facial fat in people with HIV
  83. Tesamorelin (Egrifta) is used for
    reducing excess visceral abdominal fat of HIV pts
  84. Most common AE of Lopinavir/Ritonavir (Kaletra)
  85. A cardiac AE of Lopinavir/Ritonavir (Kaletra) is
    prolonged PR and QT interval
  86. Oral solutions of Lopinavir/Ritonavir (Kaletra) should not be given to
    • full-term/preterm infants
    • pts taking disulfiram and metronadizole
  87. Enfuvirtide (Fuzeon) is a? MOA? admin?
    • HIV fusion inhibitor
    • blocks the entry of HIV into CD4 cells
    • given subQ BID
  88. Maraviroc (Selzentry) is a? MOA? use of drug is low bc?
    • CCR5 antagonist
    • blocks viral entry
    • dosing is complex; adjusted based on other drugs; expensive testing prior to therapy
  89. What are the lab tests performed in HIV therapy?
    • CD4 T-cell count
    • Viral load
    • HIV drug resistance
    • HLA-B 5701 (for Abacavir)
    • CCR5 tropism (for Maraviroc)
  90. Postexposure prophylaxis (PEP) should be initiated
    ASAP; within 1-2 hrs; no later than 72 hours
  91. When should antiretroviral be given when a mother is infected with HIV; which med?
    • during gestation and labor
    • to infant up to 6 wks postpartum
    • zidovudine
  92. Drug of choice for pneumocystis pneumonia
  93. What 4 meds are used to tx CMV in HIV pts
    • ganciclovir
    • valganciclovir
    • cidofovir
    • foscarnet
  94. Med used for meningitis in HIV pt
    • amphotericin B w/ flucytosine
    • maintenance: oral fluconazole
  95. med used to tx HSV in HIV pts
  96. tx of chlamydia for adults and adolescents
    • single 1 gm azithromycin
    • 100 mg doxycycline BID x 7 days
  97. tx of chlamydia for pregnant women
    • single 1 gm of azithromycin
    • 500 mg og amoxicillin TID x 7 days
  98. tx of urethral, cervical, and rectal gonorrhea
    • ceftriaxone 250 mg IM x 1
    • azithromycin 1 gm PO or doxycycline 100 mg PO BID x 7 days
  99. tx of PID
    cefoxitin or cefotetan with doxycycline
  100. tx of syphillis
    PCN G
  101. If pt is allergic to PCN, syphyllis can be tx with?
    doxycycline or tetracycline
  102. bacterial vaginosis is tx with?
    • nonpregnant: flagyl PO or flagyl/clindamycin cream
    • pregnant: clindamycin or flagyl PO only
  103. tx for trichomoniasis
  104. tx of genital herpes 3; MOA; admin
    • acyclovir
    • famciclovir
    • valacyclovir
    • these meds only reduce symptoms and shorten the duration of pain and viral shredding
    • every day or only when symptoms occur
  105. A patient who has HIV and is taking the nucleoside/nucleotide reverse transcriptase inhibitor (NRTI) zidovudine [Retrovir] reports vomiting, abdominal pain, fatigue, and hyperventilation. Which laboratory result is the priority for the nurse to evaluate?
    arterial blood lactate
  106. A patient has been prescribed efavirenz [Sustiva]. The nurse should instruct the patient to use which administration approach to minimize central nervous system (CNS) adverse effects?
    bedtime dosing
  107. Which is the most common bacterial sexually transmitted disease (STD) in the United States, for which the Centers for Disease Control and Prevention (CDC) has recommended annual screening in certain populations?
  108. A nurse instills 1% silver nitrate topically into the eyes of a neonate on delivery to prevent conjunctivitis caused by what?
    • chlamydia
    • gonorrhea
  109. How does sildenafil work?
    inhibits PDE5, which preserves cGMP levels in penis
  110. AE of sildenafil
    • hypotension
    • priapism
    • NAION nonarteritic ischemic optic neuropathy
    • sudden hearing loss
  111. Vardenafil causes
    QT prolongation
  112. How long is the effects of tadalafil
    36 hrs
  113. the PDE5 inhibitors are contraindicated to
    pts taking nitro or nitrates and alpha blockers
  114. Nonoral drugs for ED are usually given
    as injection or inserted in the urethra
  115. Papapverine and alprostadil is given
    via injection into corpus cavernosum
  116. what are the 2 groups of BPH drugs
    5-alpha reductase inhibitors (finasteride; dutasteride)
  117. Finasteride MOA? how long does it take to show effect?
    • ihibits 5-alpha reductase; promote regression of prostate epi tissue; decrease mechanical obstruction of urethra
    • 6-12 months
  118. AE of finasteride
    • decreased ejaculate
    • decreased libido
    • gynecomastia
  119. What is the diff of dutasteride v finasteride?
    • dutasteride reduces DHT better
    • has a longer half-life
  120. Alpha1 adrenergic antagonists
    decreases dynamic obstruction of urethra
  121. 3 of the alpha 1 blockers are nonselective
    • alfusozin
    • terazosin
    • doxazosin
  122. A patient has received a toxic dose of an antihistamine. It is most important for the nurse to assess the patient for what?
    seizure activity
  123. Which statement should the nurse include in the teaching for a patient who is to be started on zileuton [Zyflo]?
    "Have your blood drawn once a month for the next 3 months so that your liver function can be checked."
  124. A patient who has active TB is to start a medication regimen that includes pyrazinamide. The nurse identifies a risk for complications if the patient also has which medical condition?
  125. How is the transdermal contraceptive patch applied?
    • once a week x 3 weeks
    • off for 1 week
  126. Contraceptive ring is placed?
    every month
  127. When is combo OC initiated?
    • 1st day of menses OR
    • 1st Sunday after onset of menses
    • 21 days active pill
    • 7 days (off) can be inert, no pill, or iron
  128. Loestrin Fe is? dosing?
    • combo OC
    • 26 days active
    • 2 days off
  129. Introvale, Jolessa, Quasense, Seasonale dosing?
    • 84 days active
    • 7 days off
  130. Amethyst and Lybrel dosing?
  131. Guideline for postpartum use of combo OCs
    • can be started 2 wks after delivery as long as not breastfeeding
    • if breastfeeding, "mini-pill" is indicated
  132. Causes of female infertility (5)
    • anovulation and failure of follicular maturation
    • unfavorable cervical mucus
    • hyperprolactinemia
    • endometriosis
    • PCOS
  133. Baseline data needed for zodovudine
    • hgb and granulocyte d/t risk of hematologic toxicity
    • NRTI
  134. abacavir baseline data
    • screen for HLA-B 5701
    • NRTI
  135. Didanosine implementation
    • take 30 mins before meals or 2 hrs after
    • pour powdered drug into 4 oz of water (not juice or acid-containing drinks)
  136. Ribavirin should not be combined with
    allopurinol d/t risk of toxicity
  137. Efavirenz implementation
    • taken on empty stomach, preferably at bedtime (reduce CNS symptoms)
    • NNRTI
  138. Which beneficial metabolic effects does estrogen have in nonreproductive tissues?
    • It promotes and suppresses coagulation. Correct
    • It reduces low-density lipoproteins (LDLs). Correct
    • It suppresses bone resorption. Correct
  139. Progestins may be used to treat which conditions? (Select all that apply.)
    • Endometrial hyperplasia Correct
    • Dysfunctional uterine bleeding Correct
    • Endometriosis Correct
    • Amenorrhea Correct
  140. A patient tells the nurse, "I use a foam contraceptive by applying it 2 hours before having sex, and I have not gotten pregnant." What is the nurse's best response?
    "Foam contraceptives should be applied no more than 1 hour before intercourse."
  141. The nurse is aware that the primary use for misoprostol [Cytotec] is what?
    induction of abortion, cervical ripening, and induction of labor.
  142. Which statement is true about the NuvaRing?
    One ring is inserted once each month, left in place for 3 weeks, and then removed; a new ring is inserted 1 week later.
  143. The nurse is aware that which 28-day regimen is least likely to simulate ovarian production of estrogens and progestins?
  144. A nurse should report which finding of ovarian hyperstimulation in a woman receiving menotropins?
    ascites and weight gain
  145. he nurse is aware that goserelin [Zoladex] has several uses, including which? (Select all that apply.)
    • Endometriosis Correct
    • Dysfunctional uterine bleeding Correct
    • Prostate cancer Correct
    • Breast cancer Correct
  146. Which measurements should a nurse obtain to evaluate the effects of androgen therapy on the epiphyses of a patient with hypogonadism?
    Periodic hand and wrist x-rays Correct
  147. A nurse monitors for which adverse cardiovascular effects in a male patient taking testosterone [Androderm]? (Select all that apply.)
    • Pedal edema and weight gain Correct
    • Decrease in high-density lipoprotein (HDL) levels Correct
  148. Which statement should a nurse include when providing teaching to a patient who is scheduled to start taking dutasteride [Avodart]?
    "You cannot donate blood while on this medication or for 6 months after stopping it." Correct
  149. The nurse is aware that mother-to-child transmission of HIV occurs primarily during labor and delivery. Which of the following can reduce the risk of transmission? (Select all that apply.)
    • ART during gestation to minimize maternal viral load Correct
    • IV zidovudine to the mother during labor and delivery Correct
    • Oral or IV zidovudine to the infant for 6 weeks following delivery Correct
  150. Which finding does the nurse expect when assessing a male patient with secondary syphilis?
    Skin lesions and flulike symptoms Correct
  151. H pylori causes PUD likely d/t (4)
    • enzymatic degradation of mucus layer
    • cytotoxin that injures mucosal cells
    • infilitration of neutrophils
    • produces urease which forms CO2 and ammonia
  152. H pylori promotes
    gastric cancer
  153. Zollinger-ellison syndrome is
    • a rare disorder
    • caused by a tumor that secretes gastrin
  154. Goal of therapy in PUD is to (4)
    • alleviate symptoms
    • promote healing
    • prevent complications
    • prevent recurrence
    • *drugs do not alter disease process (except abx)
  155. 5 major groups of antiulcer
    • abx
    • antisecretory
    • mucosal protectant
    • antisecretory w/ enhancement
    • antacids
  156. Tx for NSAID-induced ulcers? (2)
    • PPI
    • H2 antagonist
  157. Drugs that reduce acidity should be admin in doses enough to
    raise pH at 5 and above
  158. Tests for H pylori (5)
    • invasive: endoscopy and bx
    • noninvasive: breath, stool, blood
  159. Abx used to tx H pyrlori
    • clarithromycin (inhibit protein synthesis)
    • amoxicillin (disrupt cell wall)
    • bismuth (disrupt cell wall; inhibit urease activity)
    • metronidazole
    • tetracycline (inhibit protein synthesis)
  160. Bismuth SE
    harmless black coloration of tongue and stool
  161. Metronidazole can cause
    disulfiram-like reaction when used with ETOH
  162. Antibiotic regimens for H pylori
    • if resistance to clarithromycin is low: chlarithromycin-based triple therapy: chlarit + amox + PPI
    • if resistance to clarithromycin is high:
    • bismuth-based quadruple therapy: bismuth + flagyl + tetracycline + PPI/H2RA
    • sequential therapy: PPI + amox x 5 days; then PPI + clarithromycin + tinidazole x 5 days
  163. H2RA promote; examples
    • ulcer healing by suppressing gastric acid secretion
    • ranitidine
    • cimetidine
    • famotidine
    • nizatidine
  164. Cimetidine absorption; therapeutic effects
    • decreased by food
    • 4-6 weeks of therapy
    • may be given prophylactically
  165. Cimetidine is drug of choice for tx
    • preventing aspiration pneumonitis
    • given 60-90 mins before anesthesia
  166. AE of Cimetidine (5)
    • gynecomastia
    • reduced libido
    • impotence
    • CNS effects
    • pneumonia
  167. Cimetidine can increase levels of
    • warfarin
    • phenytoin
    • theophylline
    • lidocaine
  168. Compared to cimetidine, ranitidine (3)
    • more potent
    • has fewer SE
    • has fewer drug interactions
  169. Most effective drug for suppressing gastric acid secretion
    PPIs (omeprazole, pantoprazole, -prazole)
  170. Omeprazole (Prilosec) MOA
    irreversible inhibition of H K ATPase (enzyme that generates gastric acid)
  171. Omeprazole tx should be
    limited to 4-8 weeks
  172. Omeprazole is used for (5)
    • duodenal ulcers
    • gastric ulcers
    • erosive esophagitis
    • GERD
    • long term zollinger-ellison syndrome
  173. ulcer prophylaxis should only be done (4)
    • in ICU pts
    • multiple trauma
    • spinal cord injury
    • prolonged mech ventilation
  174. AE of omeprazole (4)
    • pneumonia
    • fxs
    • rebound acid hypersecretion
    • hypomagnesemia (tremors, muscle cramps, SZ, dysrhythmias)
  175. PPIs have been associated with
    dose-related C diff
  176. Omeprazole decreases the effects of
    • Plavix
    • for pts with risk factors for GI bleeding, combining the drugs is OK
  177. Esomeprazole is used for
    prophylaxis of NSAID-induced ulcers
  178. Sucralfate inidication; AE
    • duodenal ulcers
    • create protective barrier against acid and pepsin
    • constipation
  179. Misoprostol is; therapeutic use; MOA; pregnancy category
    • an analog of prostaglandin E
    • prevention of gastric ulcers cause by NSAIDs
    • replaces endogenous prostaglandins
    • Cat X
  180. Pts about to start Misoprostol
    • comply with birth control measures
    • given oral and written warnings
    • negative serum pregnancy
    • start therapy 2-3 day of menstrual cycle
  181. ondansetron MOA; SE (3)
    • blocks 5HT (serotonin) receptors
    • headache, diarrhea, dizziness
  182. Most effective antiemetic caused by cisplatin and other antiCA drugs
    serotonin antagonists (zofran)
  183. Serious AE of ondansetron?
    • QT prolongation
    • caution: electrolyte abnormalities, heart failure, bradydysrhythmias
  184. Dose of zofran for post op n/v
    16 mg PO 1 hr before anesthesia
  185. Dolasetron AE
    fatal dysrhythmias when given in high doses
  186. Palonosetron compared to other serotonin antagonists
    • has longer half life
    • effected against both acute and delayed emesis
    • IV only
  187. Which 2 glucocorticoids are used to suppress CINV?
    • solu-medrol
    • dexamethasone
    • IV, short term, intermittent
  188. Aprepitant (Emend) is approved for? MOA? instruction?
    • preventing postop N/V and CINV
    • it blocks neurokinin1-type receptors
    • must be combined with other antiemetics (ie glucocorticoid, serotonin antagonist)
  189. Fosapretitant (Emend) is? indication?
    • prodrug convert to aprepitant in the body
    • indicated only for CINV
  190. Which benzo is used in combination with other antiemetics? benefits? (4)
    • lorazepam
    • sedation
    • suppression of anticipatory emesis
    • production of anterograde amnesia
    • control EPS
  191. Dopamine antagonist (phenothiazine) MOA; SE? (4)
    • block dopamine2 receptors
    • EPS
    • anticholinergic effects
    • hypotension
    • sedation
  192. Promethazine can cause
    • respiratory depression
    • tissue injury
  193. Promethazine is CI in
    children < 2 yrs
  194. Which route is preferred for promethazine?
    • IM
    • IV route: 25mg/mL rate of 25mg/min
  195. Butyrophenones drugs used for anti NV? MOA? SE?
    • haloperidol; droperidol
    • block dopamine2 receptors
    • EPS, sedation, hypotension, QT prolongation
  196. Which 2 cannbinoids are used to prevent CINV?
    • dronabinol (Marinol)
    • nabilone (Cesamet)
    • considered 2nd line d/t potential for abuse
  197. Dronabinol is also used to
    increase appetite in pts with AIDS
  198. Cannabinoids SE
    • temportal disintegration
    • dissociation
    • depersonalization
    • dysphoria
    • CI for pts w/ psych issues
  199. Dronabinol is classified as
    Schedule III d/t its slow onset and no interest in streets
  200. Regimens for CINV
    • High risk: aprepitant + dexamethasone + ondansetron
    • Moderate: dexamethasone + palonosetron
    • Low: Dexamethasone
  201. First-line therapy for NV in pregnancy
    • doxylamine + vit B6 (pyridoxine)
    • trade name: Dicletin, Diclegis
    • start with 2 tabs at bedtime
  202. Most effective drug for motion sickness; SE? (3)
    • scopolamine
    • dry mouth, blurred vision, drowsiness
  203. Most effective antidiarrheal agents (5)
    • opioids
    • dcrease intestinal motility
    • allow more time for absorption of fluid and electrolytes
  204. Opioids used for diarrhea
    • diphenoxylate (+atropine)
    • difenoxin (+ atropine)
    • loperamide
    • paregoric
    • opium tincture
  205. Infectious diarrhea is
    usually self-limiting and requires no treatment
  206. tx for infectious diarrhea
    • cipro or norfloxacin
    • children and pregnant women: azithromycin
  207. Prohyplaxis vaccine for diarrhea
  208. nonspecific drugs for IBS include
    • antispasmodics
    • bulf-forming agents
    • antidiarrheals
    • TCAs
  209. IBS-specific drugs include
    • alosetron (IBS-D)
    • lubiprostone (IBS-C)
    • tegaserod (IBS-C)
  210. Alosetron is indicated
    • ONLY for women with IBS-D lasting 6 mos
    • selectively blocks 5HT receptors
    • improvement should be seen in 4 weeks
  211. Alosetron should be discontinued when
    constipation occurs and ischemic colitis
  212. Tegaserod is CI
    in women with known CV disease
  213. 2 IBD are
    Crohn's and ulcerative colitis
  214. 5 drugs for IBDs are
    • 5-aminosalicylates
    • glucocorticoids
    • immunosuppressants
    • immunomodulators
    • antibiotics
    • these drugs are NOT curative
  215. Sulfasalazine is indicated for; AE?
    • IBD (mild to mod) and RA
    • hematologic disorders (CBC needed)
  216. Indications for Mesalamine, olsalazine, balasalazide
    • mesalamine: mild to mod IBD
    • olsalazine: maintenance therapy of ulcerative colitis
    • balsalazide: mild to mod active ulcerative colitis
  217. immunosuppressants used for IBD and crohn's
    • azathioprine & mercaptopurine
    • cyclosporine
    • methotrexate
    • used for LONG term therapy
  218. Immunomodulators used for IBD and crohn's
    • infliximab (remicade) TNF inhib
    • certolizumab
    • adalimumab (humira) TNF inhib
    • natalizumab (tysabri) interfere with alpha4 integrin
  219. Infliximabd (remicade) AE
    • infection (TB, opportunistic)
    • infusion reactions
  220. Abx (Flagyl and Cipro) are only effective against
    • Crohn's
    • it is not helpful in ulcerative colitis
  221. Reglan has 2 actions
    • suppress emesis
    • increase upper GI motility
    • AE: sedation, diarrhea, tardive dyskinesia
    • CI: GI obstruction, perforation, hemorrhage
  222. Pralifermin is indicated for
    • oral mucositis of pts with hematologic malignancies
    • AE: rashe, erythema, edema, discoloration of tongue
    • should be stopped 24 hrs before chemo and should not resume until after 24 hours
  223. A nurse administers which medication to inhibit an enzyme that makes gastric acid in a patient who has a duodenal ulcer?
  224. The nurse is reviewing the prescriber's orders and notes that omeprazole [Prilosec] has been ordered for a patient admitted with acute coronary syndrome (ACS). The nurse should be concerned if this medication is combined with which medication noted on the patient's record?
  225. An 80-year-old patient with a history of renal insufficiency recently was started on cimetidine. Which assessment finding indicates that the patient may be experiencing an adverse effect of the medication?
  226. A nurse is planning care for a patient undergoing chemotherapy. The care plan includes medications to reduce chemotherapy-induced nausea and vomiting (CINV). Which regimen should the nurse recognize as effective?
    aprepitant & zofran
  227. A nurse teaches a patient who has ulcerative colitis about the side effects of the treatment medication, sulfasalazine [Azulfidine]. Which statement by the patient would indicate understanding of the information?
    report any fatigue or sore throat
  228. Laxatives arre contraindicated in pts with
    • abd pain, nausea, cramps
    • symptoms of appendecitis
    • fecal impaction or obstructions of bowel d/t risk of perforation
  229. 4 classifications of laxatives based on MOA
    • bulk-forming
    • surfactant
    • stimulant
    • osmotic
  230. classification of laxatives based on therapeutic effect
    • Group I: within 2-6 hours; watery stool
    • Group II: intermediate; 6-12 hours; semifluid
    • Group III: slow 1-3 days; soft but formed
  231. Metamucil; methylcellulose (bulk-forming agent) should be taken
    with full glass of H2) to prevent esophageal obstruction
  232. Colace is a ? MOA?
    • surfactant laxative
    • lowers surface tension; inhibit fluid absorption
  233. example of stimulant laxatives?
    • bisacodyl: group II
    • senna: group II
    • castor oil: group I
  234. stimulant laxatives are indicated only for
    • opioid induced constipation
    • constipation d/t slow intestinal transit
  235. castor oil is indicated for rapid and thorough evacuation of bowels (prep for procedures)
  236. Osmotic laxative (mg salts) are CI in
    pts with kidney disease
  237. sodium phos is a? CI?
    • osmotic laxative
    • HF, HTN, edema
  238. what are the fat-soluble vits?
    A D E K
  239. what is the first indication of vit A deficiency?
    night blindness
  240. Vit A deficiency can lead to
    xeropthalmia and keratomalacia
  241. Vit A toxicity is referred to as? it can lead to?
    • hypervitaminosis A
    • birth defects
    • liver injury
    • bone-related disorders
  242. Vit A (retinol) therapeutic use?
    vit a deficiency
  243. What is the UL of vit A?
    3000 mcg/day
  244. classic effects of vit d deficiency
    • rickets (children)
    • osteomalacia (adults)
  245. Vit E helps
    protect against peroxidation of lipids
  246. High-dose vit E increases risk of
    • hemorrhagic stroke
    • doses above 200 IU/day should be avoided
  247. Vit K is required
    for synthesis of clotting factors and prothrombin
  248. Vit K deficiency can cause
    bleeding tendencies and spontaneous hemorrhage
  249. In order to prevent neonatal hemorrhage,
    Vit K (.5-1 mg) is given after delivery
  250. Ther uses for Vit K
    • thrombinemia
    • bleeding caused by Vit K deficiency
    • control of hemorrhage causes by warfarin
  251. Vit C deficiency leads to
    scurvy: faulty bone and tooth devt; loosening of teethc; gingivitis; poor wound healing; heamorrhage
  252. the UL for vit C is
    2 gm/day
  253. niacin deficiency is called
    pellagra "rough skin"
  254. riboflavin (B2) deficiency results in
    • sore throat
    • angular stomatitis
    • cheilosis
    • glossitis
  255. thiamine (b1) deficiency has two forms
    • wet beriberi (primary symptom is leg edema
    • dry beriberi (neuro and motor deficits)
  256. Pyridoxine (B6) deficiency results from
    • poor diet
    • isoniazid therapy
    • inborn errors of metabolism
  257. Pyridoxine UL is
    100 mg/day
  258. Which vit B interferes with levodopa?
    B6 (pyridoxine)
  259. folic acid deficiency results in
    • neural tube defects
    • anencephaly
    • spina bifida
  260. recommendation to ensure sufficient folate
    all women capable of being pregnant should take 400-800 mcg of folic acid each day
  261. orlistat is used to? MOA? AE? CI? DI?
    • promote and maintain weight loss
    • acts in GI tract to reduce absorption of fat by inhibiting gastric and pancreatic lipase
    • AE: oily rectal leakage, flatulence, fecal urgency, fatty/oily stools
    • can be reduced by minimizing fat intake or taking metamucil
    • CI: malabsorption syndrome or cholestasis
    • should be taken 4 hrs apart of levothyroxine
  262. Locaserin (Belviq) is used for? MOA? AE? CI? DI?
    • chronic wt loss
    • suppressed appetite and creates sense of satiety
    • headaches, back pain, decrease in lymphocytes, URI
    • pregnancy
    • serotonin syndrome w/ serotonergic drugs
  263. Which 2 sympathomimetic amines are uses for wt loss?
    • diethylpropion
    • phentermine
    • only used short term (3 mos or less)
  264. A patient who has pellagra is taking niacin. Which outcome would be most appropriate for a nurse to establish with the patient?
    smooth intact skin
  265. Which action should a nurse take when preparing to administer vitamin D to a patient diagnosed with hyperparathyroidism?
    hold the vitamin
  266. Which of the following administration techniques would be appropriate when giving a sucralfate [Carafate] tablet to a patient with a duodenal ulcer?
    • Administer the tablet with sips of water 1 hour before meals. Correct
    • Allow the tablet to dissolve in water before administering it. Correct
    • Break the tablet in half so it is easier to swallow. Correct
  267. The patient has an order for magnesium oxide/anhydrous citric acid/sodium picosulfate [Prepopik] to be given in 2 doses. The nurse knows that this medication is used for which indication?
    Preparation before a colonoscopy
  268. A nurse administers palifermin to reduce oral mucositis from chemotherapy in a patient with which type of malignancy?
  269. A nurse should teach a patient who takes alosetron [Lotronex] for diarrhea-prominent irritable bowel syndrome (IBS-D) to stop the medication immediately if the patient develops which condition?
  270. A patient who has pellagra is taking niacin. Which outcome would be most appropriate for a nurse to establish with the patient?
    Smooth, intact skin in sun-exposed areas Correct
  271. In a patient with a thiamine deficiency, which finding would indicate the development of Wernicke-Korsakoff syndrome?
    nystagmus, diplopia, ataxia
  272. Which statement about lorcaserin [Belviq] is correct
    It is classified as a Schedule IV controlled substance. Correct
  273. A female patient is given a prescription for lorcaserin [Belviq]. The nurse ensures that the patient schedules an appointment with which healthcare provider?
    OB GYn
  274. The nurse teaches the patient to monitor for which adverse effect when taking phentermine?
    tachycardia, anginal pain, and hypertension