NUR 2474 Rasmussen Pharm Exam 2 with 100% Correct Answers 2022

Loop Diuretics - ANSWER-Furosemide Thiazide Diuretics - ANSWER-Hydrochlorothiazide (HCTZ) K Sparing Diuretics - ANSWER-Spironolactone ACE Inhibitors - ANSWER-lisinopril, captopril Angiotensin 2 Receptor Blockers - ANSWER-Losartan Calcium Channel Blockers heart and vessels - ANSWER-Verapamil, Dilitizaem Calcium Channel Blockers vessels only - ANSWER-nifedipine Beta Blockers - ANSWER-Metoprolol Cardiac Glycosides - ANSWER-Digoxin K channel blocker - ANSWER-Amiodarone HMG-CoA Reductase Inhibitors - ANSWER-Lovastatin Bile Acid Sequestrants - ANSWER-Cholestyramine Colesevelam Colestipol Nitrates - ANSWER-Nitroglycerin Anticoagulant - ANSWER-Heparin Long term anticoagulant - ANSWER-Warfarin Direct thrombin inhibitors - ANSWER-Dabigatran Leukopoietic Growth Factors - ANSWER-filgrastim Drugs for hemophilia - ANSWER-Factor VIII, Factor IX concentrates, desmopressin Antidote: Digoxin - ANSWER-Digibind Antidote: Heparin - ANSWER-protamine sulfate Antidote: Warfarin - ANSWER-Vitamin K Steroids - ANSWER-Prednisone, Fluticasone Leukotriene Modifiers - ANSWER-Montelukast Short Term Bronchodilator - ANSWER-Albuterol Long term bronchodilator - ANSWER-Salmeterol Methylxanthines - ANSWER-Theophylline Anticholinergics - ANSWER-Ipratropium Tiotropium H2 receptor antagonists - ANSWER-Cimetidine Ranitidine Famotidine Nizatidine PPI - ANSWER-Omeprazole Pantoprazole Mucosal Protectants - ANSWER-Sucralfate Types of Antacids - ANSWER-Aluminum salts Magnesium salts Calcium salts Sodium bicarbonate Bulk forming laxatives - ANSWER-Psyllium Stimulant laxatives - ANSWER-Senna Surfactant laxatives - ANSWER-docusate sodium Serotonin agonists - ANSWER-ondansetron Patient Education on using inhalers - ANSWER-For any patient prescribed an inhaler, the RN should ensure the client can self administer the medication. Teach back needed The patient should wait 1-2 minutes between puffs The patient should wait 5 minutes between 2 different inhalers The patient should take a bronchodilator before a corticosteroid medication (B before C) The patient must keep track of doses on their inhaler If opening a new inhaler, the patient should shake it and test before use. If dexterity is limited, a spacer can be used to get more medication in the airway. If the patient uses a steroid, they must wash their mouth out after use. If not, fungal infection may occur The patient should hold breath 10 seconds after receiving a puff. short-term asthma treatment - ANSWER-Bronchodilator: albuterol Acts as a rescue inhaler during asthma attacks. Onset is in 5 minutes and will last longer. Xanthine Derivatives: theophylline Dilates airways Can have high drug interactions in the body IV/ inhaled glucocorticoids. long term asthma treatment - ANSWER-Bronchodilator: salmeterol. Used to control symptoms of asthma Never is used alone (often with steroid) Anticholinergics: ipratropium bromide For long term asthma prevention Works very slowly. Corticosteroids: fluticasone Non bronchodilation Can take several weeks to show COPD treatment - ANSWER-Bronchodilator- short acting albuterol Steroid Must keep o2 saturation between 88-92% Most asthma treatments require what? - ANSWER-Combination of medications- most medications cannot be used alone (need bronchodilator plus steroid) Rescue inhalers - ANSWER-Quickly relax airways. albuterol, epinephrine, metaproterenol, IV steroid Long term inhalers - ANSWER-salmeterol, ipratropium, theophylline, montelukast ,fluticasone Treatment of acute asthma attack - ANSWER-Oxygen use Short acting bronchodilator- albuterol Corticosteroid- ipratropium bromide IV Will relieve hypoxemia, reduce airway inflammation, and relieve obstruction. Bronchodilator mechanism of action - ANSWER-mimics the sympathetic NS and opens up the lungs and stimulates beta receptors Fast acting vs. long term asthma relief - ANSWER-Fast acting: used for acute asthma relief, Long acting is for chronic asthma management and COPD AE of bronchodilators - ANSWER-tachycardia, angina, tremors, nervous and shaky feeling, hyperglycemia. Pt teaching for bronchodilators - ANSWER-ensure patient takes medication as prescribed and does not overuse short acting bronchodilator. Never use it alone with asthma treatment. Glucocorticoid mechanism of action - ANSWER-works to stop the inflammatory process in the lungs, preventing bronchoconstriction. Stabilizes WBC membranes that release bronchial constricting substances, increases bronchial smooth muscle beta adrenergic stimulation. Forms of Glucocorticoids - ANSWER-Inhaled: used for asthma and is the most tolerated and fast acting, but can also be IV for systemic effects on the body. AE of glucocorticoids - ANSWER-throat and mouth irritation, dry mouth, oral fungal infections. Pt teaching for glucocorticoids - ANSWER-must teach patients to rinse mouth out after steroid use to prevent oral fungal infections, take bronchodilator 5 mins before steroid. Tiotropium mechanism of action - ANSWER-treats maintenance therapy and bronchospasm in patients with COPD. Will block muscarinic receptors in lungs how can we administer tiotropium? - ANSWER-inhaler What should we not use tiotropium for? - ANSWER-asthma Tiotropium onset and therapeutic level timeframes - ANSWER-Therapeutic effects start 30 min post inhalation, peaks in 3 hrs, and lasts 24 hrs. With consistent dosing, bronchodilation will improve after 8 days. Anticholinergic side effects - ANSWER-blurred vision, dry mouth, tachycardia, constipation, urinary retention How can we help aid patient experiencing anticholinergic effects? - ANSWER-give hard candy or fluids to suck on OTC sympathomimetics and cardiac patients - ANSWER-Sympathomimetics stimulate the immune system and cause vasoconstriction widespread and interfere with BP. Found in many cold and allergy medications. Patients with cardiac problems must have caution with use of these drugs and hypertension treatment. Treatment principles of cold symptoms in children - ANSWER-Must treat individual symptoms. Many medications used OTC to treat colds are combination medications. In children, it can be dangerous if used as a combination medication for a cold. The parent should treat the symptoms only with individual agents and only with agents indicated for pediatric use. Best preventions of NSAID induced ulcer formation? - ANSWER-Use PPI or H2receptor blocker and stop NSAID if possible NSAID use increases what? - ANSWER-Ulcer formation Antacids: Mechanism of Action - ANSWER-Do not prevent the overproduction of acid but instead help to neutralize acid secretions Promote gastric mucosal defense mechanisms Stimulate secretion of: -Mucus: protective barrier against HCl -Bicarbonate: helps buffer acidic properties of HCl -Prostaglandins: prevent activation of proton pump Adverse effects of antacids - ANSWER-constipation, diarrhea, metabolic alkalosis, renal calculi H2 receptor blocker mechanism of action - ANSWER-works to block H2 receptors, reduce H ion secretion in parietal cells, suppress acid secretion and increase stomach pH Adverse effects of H2 receptor blocker use - ANSWER-CNS confusion and depression in older adults, decreased libido, impotence and gynecomastia. IV bolus= hypotension and dysrhythmias antacids and cimetidine - ANSWER-Antacids will reduce absorption of cimetidine. The patient must wait 1 hr before taking cimetidine and antacids What should a patient do before purchasing any OTC medications - ANSWER-Consult HCP GERD treatment principles - ANSWER-GERD there is a problem with the lower esophageal sphincter, allowing for acid to go up into the esophagus from the stomach. Will use PPI if anything to help. Once patient stops PPI, they can relapse and have GERD symptoms Relapse of GERD is often why medications are taken for long term maintenance. However, short term use may occur also. PPI mechanism of action - ANSWER-help to prevent movement of hydrogen ions from cells into the stomach. causes all gastric acid secretions to be blocked (no HCl is produced!) PPI uses - ANSWER-GERD, esophagitis, short term gastric and duodenal ulcers, NSAID ulcers, stress ulcers, H. pylori formed ulcers. Adverse effects of PPI - ANSWER-HA, GI effects- D,N,V, pneumonia, osteoporosis, fractures, hypomagnesemia, , gastric cancer. Route to give PPI - ANSWER-PO IV NG PPI and use in older adults - ANSWER-encourage older adults to consume adequate calcium and vitamin D on PPI, as therapy can increase risk for fractures and osteoporosis. Sucralfate mechanism of action - ANSWER-It works by attaching and binding to the base of ulcers, forming a proactive barrier over the area. It can then protect areas from pepsin that can break down proteins and make ulcers worse. Sucralfate uses - ANSWER-treats stress ulcers and PUD. Adverse effects of sucralfate use - ANSWER-constipation, nausea, dry mouth. What must we do when administering sucralfate? - ANSWER-must give other drugs 2 hrs before due to impairment of other drug absorption What should we do first before giving a patient medications such as laxatives for constipation? - ANSWER-assessment rule out other causes of constipation such as from medications, small bowel obstruction- must take X-ray and listen to bowel tones Constipation is - ANSWER-occurring when the patient has hard stools, infrequent stools, excessive straining, and unsuccessful defecation. Can diet be a cause of constipation? - ANSWER-yes- having a diet in low in fiber and fluids can cause it Treatment is to correct the diet Purpose of laxative use - ANSWER-They can reduce painful bowel elimination. Decrease strain to prevent vasovagal stimulation. Empty the bowel before treatment procedures Obtain a fresh stool sample. Assist with loss of bowel tones. Bulk forming laxative administration and principles - ANSWER-Works by absorbing water to increase bulk and soften stool. It also causes bowel distention to initiate reflex bowel activity. The patient should take with full cup of water to aid in action How do opiate laxatives work? - ANSWER-Works to decrease bowel motility and reduce pain by relief of muscle spasms. They also decrease transit time of stool through the bowel, allowing more time for water and electrolytes to be absorbed. Opiate laxatives use - ANSWER-patients with frequent diarrhea, to decrease stool in ileostomy and decrease diarrhea from opioid withdrawal. Important opiate laxative consideration - ANSWER-If a patient takes too much of an opiate due to its dependent effects, a patient may experience s/s similar to morphine and may cause an increased constipation. The patient will need naloxone to help reverse this cause. Senna mechanism of action - ANSWER-stimulates the intestines and works to increase peristalsis via intestinal nerve stimulation. What side effect is important to teach patient regarding Senna use? - ANSWER-must teach the patient they may have a yellow/brown or pink color to the urine that is harmless. Surgical patients and use of stool softeners - ANSWER-Stool softeners will help the stool pass easier through the hypoactive bowel. It will not stimulate bowel activity. Will help with post surgical constipation. Ondansetron mechanism of action - ANSWER-blocks receptors located in the vagal nerve, GI tract, and chemoreceptor trigger zones in the CNS. Ondansetron treats... - ANSWER-nausea and vomiting, CINV, post op NV Side effects of ondansetron - ANSWER-HA, diarrhea, dizziness, prolonged QT interval, risk of torsades de pointes concurrent use of furosemide and digoxin causes what? - ANSWER-hypokalemia- must cease use of furosemide and switch to spironolactone and monitor K levels and EKG readings. Give K supplement to increase K levels if needed Loop diuretics do what? - ANSWER-block absorption of Na, K ,Cl and water, Causes rapid diuresis. Both Loop diuretics and K sparing diuretics treat what? - ANSWER-HF Hypertension. edema AE of loop diuretics - ANSWER-hypotension ,dehydration, hyponatremia, hypokalemia, hypochloremia What should we give patient taking loop diuretic to increase K levels? - ANSWER-K supplements K sparing diuretics do what? - ANSWER-block absorption of Na and water, and causes the body to hold onto K. Excretes water and Na only AE of K sparing diuretics - ANSWER-hypotension, hyperkalemia (the person holds onto more potassium), drowsiness, metabolic acidosis, gynecomastia, breast tenderness, irregular menstrual cycle, impotence. What nursing interventions should we do with the patient taking K sparing diuretics / - ANSWER-monitor ECG so we can assess for arrhythmia related to high K levels, no salt substitutes should be used Concurrent use of Furosemide and Gentamicin causes what? - ANSWER-increased ototoxicity- pt must report s/s of tinnitus or hearing loss What causes angioedema? - ANSWER-ACE inhibitors and A2RB use S/S of angioedema - ANSWER-facial and tongue swelling. Can be fatal. Patient education regarding angioedema - ANSWER-The patient with angioedema must discontinue ACE inhibitors or A2RB drugs and never use them again. ACE inhibitors and coughing - ANSWER-Side effect of drug. Can be irritating. Due to increased bradykinin. Can give cough drops to help but if the patient doesn't tolerate coughing, we must switch them to another medication Side effects of ACE inhibitors - ANSWER-1st dose hypotension, dry cough, angioedema, hyperkalemia, fetal injury. Pt teaching for 1st dose hypotension with ACE - ANSWER-change position slowly Dry cough relief for ACE use - ANSWER-Sucking on hard candy or cough drop. However, if they cannot handle the medication because of a cough, they must notify the provider to switch medication. Angioedema teaching for patient taking ACE - ANSWER-report s/s. never use ACE drugs again Hyperkalemia ACE teaching - ANSWER-The medication causes K retaining. They must avoid foods high in potassium. They also must avoid salt substitutes as they are full of potassium.