NR 293 Final Exam Study Guide Latest 2022-2023, Exams of Nursing

Download NR 293 Final Exam Study Guide Latest 2022-2023 and more Exams Nursing in PDF only on Docsity! 1 Final Exam Study Guide ● Sildenafil (Viagra) ○ Class: erectile dysfunction agents, vasodilators (phosphodiesterase type 5 inhibitors) ○ Used for erectile dysfunction ○ Enhances effects of nitric oxide released during sexual stimulation ○ Contraindicated in hypersensitivity and concurrent use of nitrates or riociguat ■ Concurrent use with nitrates = may cause life-threatening hypotension ■ Concurrent use with riociguat = may result in severe hypotension ○ Most frequent side effects: headache, flushing, dyspepsia ○ Life-threatening side effects: myocardial infarction and sudden death ○ Dose = 25 mg taken 1 hour before sexual activity ○ Sildenafil offers no protection against STDs, advice patient that protection against STDs and HIV should be considered ○ Sildenafil (viagra) = can be given to neonates with hypertension ○ Do not take with high fat foods = high fat foods delay absorption and reduce peak effects ○ can exacerbate hypertension with BPH drugs ● EC aspirin education (enteric coated aspirin) ○ Class: antipyretics, nonopioid analgesics (pharm: salicylates) ○ Patients should not crush or chew enteric-coated tablets ○ DO NOT take antacids within 1-2 hours of enteric-coated tablets ● Bumetanide ○ Suffix: -ide ○ Class: diuretic/loop diuretic ○ Indications: Edema due to heart failure, hepatic disease, or renal impairment (unlabeled use: reversal of oliguria in preterm neonates) ○ MOA: Inhibits the reabsorption of sodium and chloride from the loop of Henle and distal renal tubule. Increases renal excretion of water, sodium chloride, magnesium, potassium, and calcium. Effectiveness persists in impaired renal function. ○ Routes: PO, IM, IV ○ Contraindications: Hypersensitivity, cross-sensitivity with thiazides and sulfonamides may occur, hepatic coma or anuria 2 ○ Life-threatening side effects: stevens-johnson syndrome, toxic epidermal necrolysis ○ Most frequent side effects: dehydration, hypochloremia, hypokalemia, hypomagnesemia, hyponatremia, hypovolemia, metabolic acidosis ○ Other info: ■ Assess patient for skin rash frequently during therapy ■ Discontinue medication at first sign of rash ○ High ceiling loop diuretics = can cause ototoxicity ■ Education on tinnitus and hearing loss ● Furosemide X 10 (Lasix) ○ Class: diuretics (pharm: loop diuretics) ○ Indication: Edema due to heart failure, hepatic impairment, or renal disease; Hypertension ○ MOA: Inhibits the reabsorption of sodium and chloride from the loop of Henle and distal renal tubule. Increases renal excretion of water, sodium, chloride, magnesium, potassium, and calcium. Effectiveness persists in impaired renal function. ○ Desired effects: Decreased BP ○ Route: PO, IM, IV ○ Contraindications: Hypersensitivity, cross-sensitivity with thiazides and sulfonamides, hepatic coma or anuria, avoid in patients with alcohol intolerance ○ Side effects: ■ (Life-threatening): erythema multiforme, stevens-johnson syndrome, toxic epidermal necrolysis, aplastic anemia, agranulocytosis ■ (Most frequent): Dehydration, hypoglycemia, hypochloremia, hypokalemia, hypomagnesemia, hyponatremia, hypovolemia, metabolic acidosis ○ Interactions: ■ Antihypertensives, nitrates, acute ingestion of alcohol = increased risk of hypotension ■ Other diuretics, amphotericin B, stimulant laxatives, corticosteroids = increased risk of hypokalemia ■ Aminoglycosides or cisplatin = increased risk of ototoxicity ■ Cisplatin = increased risk of nephrotoxicity ■ NSAIDs = decreased effects of furosemide 5 ● Omeprazole (Prilosec) ○ Class: antiulcer agent (proton-pump inhibitors) ○ Indications: heart burn lasting longer than 2 weeks; GERD maintenance, duodenal ulcers ○ MOA: Binds to an enzyme on gastric parietal cells in the presence of acidic gastric pH, preventing the final transport of hydrogen ions into the gastric lumen. ○ Therapeutic Effects: Diminished accumulation of acid in the gastric lumen with lessened gastroesophageal reflux. Healing of duodenal ulcers. ○ Life-threatening side effects: CDAD ○ Most-frequent side effects: Abdominal pain ○ Educate patients about signs and symptoms of respiratory infections ○ Swallow capsule whole = unstable in stomach acid (do not crush or chew) ● Cimetidine X 2 ○ Class: antiulcer agents (Histamine H2 antagonists) ○ hypoglycemics ○ Therapeutic effects: ■ reduce stomach acid to treat ulcers and reflux (Decreased secretion of gastric acid) ■ Healing and prevention of ulcers. ■ Decreased symptoms of gastroesophageal reflux. ○ Drug interactions: other drugs metabolized by the liver ex: benzodiazepines and beta blockers increase drug serum levels and toxicity ○ Indications: ■ Management of gastric hypersecretory states ■ Short-term treatment of active duodenal ulcers and benign gastric ulcers. ■ Maintenance therapy for duodenal and gastric ulcers after healing of active ulcers. ■ Management of GERD. ■ Treatment of heartburn, acid indigestion, and sour stomach ○ Life-threatening side reactions: agranulocytosis, aplastic anemia ○ Most frequent: confusion 6 ○ Other SE: constipation, diarrhea, drug-induced hepatitis, decreased sperm count, erectile dysfunction ○ Other info: ■ Monitor CBC with differential periodically during therapy ○ Eat 5-6 small meals throughout the days = slows absorption to prolong therapeutic effects ○ This drug is a histamine which can produce effects such as: lethargy, depression, confusion, seizures ● Esomeprazole ○ Class: Antiulcer agents (Pharm: proton-pump inhibitors) ○ Indications: GERD/erosive esophagitis ○ MOA: Binds to an enzyme on gastric parietal cells in the presence of acidic gastric pH, preventing the final transport of hydrogen ions into the gastric lumen. ○ Therapeutic effects: ■ Diminished accumulation of acid in the gastric lumen with lessened gastroesophageal reflux. ■ Healing of duodenal ulcers. ■ Decreased incidence of gastric ulcer during continuous NSAID therapy. ○ Contraindications: ■ Hypersensitivity to esomeprazole or related drugs (benzimidazoles) ■ Concurrent use of rilpivirine ○ Life-threatening side-effects: ■ Clostridium difficile-associated diarrhea (CDAD) ○ Side effects: ■ Vitamin B12 deficiency ■ Headache ■ Hypomagnesemia ○ Severe hepatic impairment = dose should not exceed 20 mg/day ● Bisacodyl (Dulcolax) ○ Class: Laxative (Pharm: stimulant laxatives) ○ Indications: Treatment of constipation 7 ○ Action: Stimulates peristalsis. Alters fluid and electrolyte transport, producing fluid accumulation in the colon ○ Therapeutic effects: ■ Evacuation of the colon. ■ Soft, formed bowel movement when used for constipation. ○ Contraindications: ■ Hypersensitivity ■ Abdominal pain ■ Obstruction ■ Nausea or vomiting (especially with fever or other signs of acute abdomen) ○ Most frequent side effects: ■ Abdominal cramps ■ nausea ● Prostate Cancer (will review in class) ● Cisplatin and bladder cancer ○ Class: antineoplastic (pharm: alkylating agents) ○ Indications: Metastatic testicular and ovarian carcinoma. Advanced bladder cancer. Head and neck cancer. Cervical cancer. Lung cancer. Other tumors. ○ MOA: death of rapidly replicating cells, particularly the malignant ones. ○ Route: only available in injectable form (IV) ○ Drug Interations: nephrotoxicity and ototoxicity with other nephro/oto toxic drugs (aminoglycoside, loop diuretics) ○ before administration CBC must be >4,000 and platelets >100,000 ○ Treats solid tumors ○ Anemia can be a side effect = bone marrow suppression ● Ciprofloxacin ○ Class: anti-infectives (pharm: fluoroquinolones) ○ Indications: ■ Treatment of UTIs (cystitis and prostatitis) ■ gynecologic infections ■ Respiratory tract infections (acute sinusitis, acute exacerbations of chronic bronchitis, and pneumonia) 10 ○ Folic acid antagonist. Interferes with the use of folic acid. As a result, DNA is not produced, and the cell dies. Also used to treat severe cases of psoriasis and rheumatoid arthritis ○ Adverse Effects: ■ Hair loss, nausea and vomiting, myelosuppression ■ Neurologic, cardiovascular, pulmonary, hepatobiliary, GI, genitourinary, dermatologic, ocular, otic, and metabolic toxicity ■ Tumor lysis syndrome ■ Palmar-plantar dysesthesia (also called hand-foot syndrome), Stevens-Johnson syndrome, toxic epidermal necrolysis ○ Monitor for gout = adverse effect ○ Drink fluids to minimize effects and report edema or joint pain ● Alendronate ○ Class: bone resorption inhibitors (Bisphosphonates) ○ Most frequent side effects: ■ Musculoskeletal pain ○ Other side effects: ■ CNS: Headache ■ CV: atrial fibrillation ■ DERM: erythema, photosensitivity, rash ■ EENT: blurred vision, conjunctivitis, eye pain/inflammation ■ GI: Abdominal distention, abdominal pain, acid regurgitation, constipation, diarrhea, dyspepsia, dysphagia, esophageal cancer, esophageal ulcer, esophagitis, flatulence, gastritis, taste perversion, vomiting ○ (More side effects on page 121 in the online Davis drug book) ● Lithium ○ Class: Mood stabilizer ○ Indications: treatment and maintenance of acute manic and mixed episodes associated with bipolar I disorder. 11 ○ Therapeutic levels range from 0.5–1.5 mEq/L for acute mania. Long term control is 0.6–1.2 mEq/L. Serum concentrations should not exceed 2.0 mEq/L (toxic). ○ Lithium toxicity (vomiting, diarrhea, slurred speech, lightheadedness, decreased coordination, drowsiness, muscle weakness, tremor, or twitching). If these occur, report before administering next dose. ○ keep sodium WNLs 135-140 mEq/L ○ Adverse effects: cardiac dysrhythmias ○ Long term use can lead to hypothyroidism (increase in TSH bc lack of TH) ○ Avoid outdoor heat -> dehydration -> toxicity ○ decreases dopamine and norepine in the brain while increasing serotonin ● Donepezil ○ Class: anti-alzheimer’s agents (Pharm: cholinergics - cholinesterase inhibitors) ○ Indications: Mild, moderate, or severe dementia/neurocognitive disorder associated with Alzheimer’s disease. ○ MOA: moderate, or severe dementia/neurocognitive disorder associated with Alzheimer’s disease. ○ Therapeutic effects: Inhibits acetylcholinesterase thus improving cholinergic function by making more acetylcholine available. ■ Improvement in cognitive function (memory, attention, reasoning, language, ability to perform simple tasks) in patients with Alzheimer’s disease. ○ Contraindications: hypersensitivity to donepezil or piperidine derivatives ○ Most frequent side effects: ■ Headache ■ Diarrhea ■ Nausea ● Fluoxetine & Depression ○ Class: antidepressants (pharm: selective serotonin reuptake inhibitors (SSRIs) ○ Assess for suicidal tendencies, especially during early therapy. ○ Restrict the amount of drug available to patients. ○ Risk may be increased in children, adolescents, and adults younger than 24 years old 12 ○ After starting therapy, children, adolescents, and young adults should be seen by a health care professional at least weekly for 4 wk, every 3 wk for next 4 wk, and on advice of a health care professional thereafter. ○ ● Amphotericin B and lab values ○ Class: Antifungals ○ Monitor CBC, BUN and serum creatinine, and potassium and magnesium levels daily. ■ If BUN and serum creatinine increases significantly, medication may need to be discontinued or switched to lipid complex, or liposomal formulation. ● Alcohol withdrawal and medication ○ Dexmedetomidine is also commonly used in the intensive care setting for sedation of mechanically ventilated patients ○ it is also used in patients experiencing alcohol withdrawal. ○ Lower doses may be needed with the concurrent administration of anesthetics, sedatives, or opioids. ○ Side effects include hypotension, bradycardia, transient hypertension, and nausea. ● Disulfiram ○ ● Levothyroxine: Overdose and Therapeutic effect. ○ Class: Hormones (Pharm: thyroid preparations) ○ Overdose is manifested as hyperthyroidism (tachycardia, chest pain, nervousness, insomnia, diaphoresis, tremors, weight loss). ○ Usual treatment is to withhold dose for 2–6 days then resume at a lower dose. ○ Acute overdose is treated by induction of emesis or gastric lavage, followed by activated charcoal. ○ Sympathetic overstimulation may be controlled by antiadrenergic drugs (beta blockers), such as propranolol. ○ Oxygen and supportive measures to control symptoms are also used. ○ ● Phenytoin PO and IV 15 ■ Hypersensitivity reactions ○ Most frequent SE: ■ Dizziness ■ Drowsiness ■ Headache ■ Constipation ■ Dyspepsia ■ Nausea ○ Education: Caution patient to avoid the concurrent use of alcohol, aspirin, acetaminophen, or other OTC medications without consulting health care professional. Use of naproxen with 3 or more glasses of alcohol per day may increase risk of GI bleeding. ● Prednisone and RA ○ Class:Antiasthmatics, corticosteroids (Pharm: corticosteroid - systemics) ○ Used systemically and locally in a wide variety of chronic diseases including: Inflammatory, Allergic, Hematologic, Neoplastic, Autoimmune disorders. ○ Used systemically and locally in a wide variety of chronic diseases including: Inflammatory, Allergic, Hematologic, Neoplastic, Autoimmune disorders. ○ Stopping the medication suddenly may result in adrenal insufficiency (anorexia, nausea, weakness, fatigue, dyspnea, hypotension, hypoglycemia). If these signs appear, notify health care professional immediately. This can be life threatening. ● Dopamine IV X 2 (therapeutic effect) ○ Adjunct to standard measures to improve: BP, Cardiac output, Urine output in treatment of shock unresponsive to fluid replacement. Increase renal perfusion (low doses). ○ Desired outcomes: ■ Increase in BP. ■ Increase in peripheral circulation. ■ Increase in urine output. ● Zidovudine ○ ● Vancomycin and flushing 16 ○ “Red man” syndrome occurs with rapid infusion ■ Side effect is bothersome, but usually not harmful ■ characterized by flushing and/or itching of the head, face, neck, and upper trunk area. ■ It is most commonly seen when the drug is infused too rapidly. ■ It can usually be alleviated by slowing the rate of infusion of the dose to at least 1 hour. ■ Rapid infusions may also cause hypotension. ● Penicillin G Procaine: Allergic reaction ○ Observe patient for signs and symptoms of anaphylaxis: (rash, pruritus, laryngeal edema, wheezing). ■ Discontinue drug and notify health care professional immediately if these symptoms occur. ■ Keep epinephrine, an antihistamine, and resuscitation equipment close by in case of an anaphylactic reaction. ○ ● Ibuprofen ○ Indications: Treatment of mild to moderate pain fever, inflammatory disorders including rheumatoid arthritis (including juvenile) and osteoarthritis, Dysmenorrhea. ○ MOA: Inhibits prostaglandin synthesis ○ Desired outcomes: decreased pain and inflammation, reduction of fever ○ Contraindications: ■ Hypersensitivity ■ Active GI bleeding or ulcer disease ■ History of recent myocardial infarction ■ Severe heart failure ■ Avoid after 30 wk gestation (may cause premature closure of fetal ductus arteriosus) ○ Life-threatening side effects: ■ Heart failure ■ myocardial infarction ■ stroke ■ Exfoliative dermatitis ■ Stevens-johnson syndrome ■ Toxic epidermal necrolysis ■ GI bleeding ■ Hepatitis 17 ■ Hypersensitivity reactions ○ Most frequent side effects: ■ Headache ■ Constipation ■ Dyspepsia ■ Nausea ■ Vomiting ○ Other info.: ■ Patients who have asthma, aspirin-induced allergy, and nasal polyps are at increased risk for developing hypersensitivity reactions. ● Assess for rhinitis, asthma, and urticaria. ■ Assess patient for skin rash frequently during therapy. ● Discontinue ibuprofen at first sign of rash; may be life-threatening. ● Stevens-Johnson syndrome or toxic epidermal necrolysis may develop. Treat symptomatically; may recur once treatment is stopped. ■ Caution patient that use of ibuprofen with 3 or more glasses of alcohol per day may increase the risk of GI bleeding. ■ Advise patient to consult health care professional if rash, itching, visual disturbances, tinnitus, weight gain, edema, epigastric pain, dyspepsia, black stools, hematemesis, persistent headache, or influenza-like syndrome (chills, fever, muscle aches, pain), or cardiovascular events (chest pain, shortness of breath, weakness, slurring of speech) occurs. ● Metronidazole ○ Main side effect = metallic taste ○ Use cautiously if the patient has seizures, liver, heart, and renal failure ○ Can cause ataxia, vertigo, and seizures ● Chlorpromazine: what can it cause? ○ ● Chlorpromazine medication calculation ○ ● Levodopa/Carbidopa and Parkinson’s disease ○ Indications: Parkinson’s disease 20 ○ If regular insulin is mixed with NPH, always draw up the regular insulin into the syringe first. ■ When mixing insulin in a syringe, always draw up the fastest acting insulin first. ○ To reduce the number of required insulin injections per day, regular insulin is often combined with NPH insulin for administration. ○ Clear before cloudy ● Morphine and nursing priority ○ Assess level of consciousness, BP, pulse, and respirations before and periodically during administration ○ Check respiratory rate ■ A respiratory rate that is <10 breaths/min may indicate respiratory depression = report to prescriber ■ With morphine or similar drugs withhold the dose and contact the prescriber if there is a decline in patient condition or abnormal vital signs = especially respiratory depression! ○ Assess for risk of opioid addiction, abuse, or misuse prior to administration ○ Reversal of respiratory depression or coma = naloxone is the antidote ● Wrong medication administration ○ Check vitals ○ Inform ● Lisinopril and therapeutic effect ○ Class: antihypertensives (Pharm: ACE inhibitors) ○ Therapeutic effects: ■ Lowering of BP in hypertensive patients. ■ Improved symptoms in patients with HF (selected agents only). ■ Decreased development of overt heart failure (enalapril only). ■ Improved survival and decreased development of overt HF after MI (selected agents only). ■ Decreased risk of death from cardiovascular causes or MI in patients with stable CAD (perindopril only). ● Timolol eye drops 21 ○ Beta adrenergic blocker ○ May produce a minimal increase in aqueous outflow and decreases production of aqueous flow ○ Relieves intraocular pressure ○ Do not freeze, must be refrigerated ○ Avoid contamination, do not touch dropper to eye ○ INDICATION: open-angle glaucoma and ocular hypertension ○ DOSAGE: one drop twice daily ■ Gel forming solution: one drop daily ○ Take at the same time every day daily ○ Drops and then ointment ● Glipizide and MOA ○ Lower blood glucose by stimulating the release of insulin from the pancreas and increasing the sensitivity to insulin at receptor sites. May also decrease hepatic glucose production ○ (Rapidly stimulates the pancreas to release insulin) ○ Facilitates the transport of excess glucose from the blood into the cells of muscles, liver, and adipose tissues ● Warfarin: lab value ○ Monitor PT, INR and other clotting factors frequently during therapy; monitor more frequently in patients with renal impairment. ○ Therapeutic PT ranges 1.3–1.5 times greater than control; however, the INR, a standardized system that provides a common basis for communicating and interpreting PT results, is usually referenced. ○ Normal INR (not on anticoagulants) is 0.8–1.2. ○ An INR of 2.5–3.5 is recommended for patients at very high risk of embolization ● With hyperthyroidism = Low TSH ● With hypothyroidism = High TSH Medication Calculation Practice Answers: 1. 2 capsules 22 2. 1.5 mL 3. 4 tablets 4. 1.3 mL 5. 1 mL per dose