2024 NSG 251 FINAL EXAM WITH
CORRECT ANSWERS
Rank speed of absorption: Po, IM, IV - CORRECT-ANSWERSPo slowest, then
IM, IV fastest
Describe drug distribution in relation to protein binding - CORRECT-
ANSWERSProtein binding- Most drugs form a compound and bind with
plasma proteins. Drug molecules bound to plasma proteins are
pharmacologically inactive. Only the free or unbound portions of the drug
acts on the cells. Protein binding allows for some of the drug to be stored
and others to be released as needed. This gives the constant blood level and
decreased risk for toxicity.
High binding=high duration of action.
Proton pump inhibitors - CORRECT-ANSWERS-Inhibit gastric acid secretions
and prevent pumping of gastric acid from parietal cells
-Drugs in this category:
omeprazole (Prilosec) = prototype; OTC
lansoprazole (Prevacid)
pantoprazole (Protonix) = IV
-Drugs are stronger and more powerful that H2 drugs
-In respects to Tx, pt would try an H2 first before being put on a proton pump
inhibitor
-Drugs are used for erosive gastritis, symptomatic GERDs, stress ulcers (in
ICU pt), H. pylori (bacteria that causes ulcers)
-Drugs have minimal adverse effects, but should be discontinued when pt is
ready to go home
Nursing implications for proton pump inhibitors - CORRECT-ANSWERS-Ulcers
should heal in 4-8 weeks
-If giving pills they should be swallowed whole
-Give before meal/food
Nursing implications for iron - CORRECT-ANSWERS-Take before meals, on
empty stomach (most people can't tolerate this = causes N/V = decrease
effect of drug)
-Take w/full glass of water
-Warn pt of GI upset, iron will make stool black (they aren't bleeding)
,-Drug in liquid form = drink w/straw b/c drug will stain teeth
Reasons for use of the cholinergic drugs - CORRECT-ANSWERSIncrease
bladder tone, relax sphincters. (increased muscle tone allows bladder to
empty)
Side effects of anticholinergic drugs - CORRECT-ANSWERSAtropine:
Tachycardia (from high dose), blurred vision
oxybutynin (Ditropin) & tolterodine (Detrol): dry mouth, constipation, blurred
vision
Benzodiazepines/nursing - CORRECT-ANSWERS**diazepam (Valium),
alprazolam (Xanax), lorazepam (Ativan), midazolam (Versed)**
-Used for sleep, anxiety, preop, and alcohol withdraw
-Adverse effects are oversedations, hangover effect, and decreased
respirations
-Persists for days after discontinued
-Can cause opposite responses in elderly!!!!----excited, aggressive, anxious
-Safety--decreased consciousness---fall risk
-Flumazenil (Romazicon) is the reversal agent
-Give with food, abstain from ETOH, watch OTC medications for sedation
-Taper medication----withdraw will occur if stopped suddenly
-Dependence can occur----short term use only
-"Nerve pills"----taken for anxiety to treat symptoms
phenobarbital (Luminal) - CORRECT-ANSWERSNot used much anymore
Has serious dependence issues and withdrawal
Hangover effect, drowsiness, and suicidal ideation
phenytoin (Dilantin) - CORRECT-ANSWERSSeizures
-Caution: severe kidney/liver disease, elderly
-Careful IV infusion--irritating to veins and painful!
-Give w/food to reduce upset stomach
-Good oral hygiene because of gingival hyperplasia adverse effect
-Generic/trade brands not always same--stay with same brand
-Many medication interactions--check with pharmacist
-Do not abruptly stop medication--if stopped could experience more seizures
Pt needs to wear Medic alert band
dantrolene (Dantrium) - CORRECT-ANSWERSUsed to threat malignant
hyperthermia- runs in families- symptoms occur when exposed to anesthesia
i.e. surgery
Drugs for tx of ADHD - CORRECT-ANSWERSCNS Stimulants (stimulates the
cerebral cortex):
,amphetamine (Adderall), methylphenidate (Ritalin), guanfacine (Intuniv),
atomoxetine (Strattera- new)
-Adverse: can have the opposite effect in children
*concern that ADHD is over diagnosed
-can also be used to treat narcolepsy, weight reduction
-High potential for tolerance- Schedule II
Abortive therapy for migraines - CORRECT-ANSWERStriptans/serotonin
agents
-sumatriptan (Imitrex), zolmitriptan (Zomig)
-Contraindications: CAD, HTN, pregnancy, do not give within 24 hours of
ergot alkaloids
Preventative therapy for migraines - CORRECT-ANSWERS-valporic acid
-gabapentin (Neurotin)
-topiramate (Topamax)
-Beta blockers, calcium channel blockers, TCA
Status epileptus - CORRECT-ANSWERSA seizure that lasts longer than 5
minutes
Patient education/nursing responsibilities for medications for seizures -
CORRECT-ANSWERSphenobarbital (Luminal)--Depress CNS (treat seizures)
--Not used much anymore
--Has serious dependence issues and withdrawal
--Hangover effect, drowsiness, and suicidal ideation
phenytoin (Dilantin)*--stabilizes nerve membranes (10-20mcg/ml therapeutic
range)
--Caution: severe kidney/liver disease, elderly
--Careful IV infusion--irritating to veins and painful!
--Give w/food to reduce upset stomach
--Good oral hygiene because of gingival hyperplasia adverse effect
--Generic/trade brands not always same--stay with same brand
--Many medication interactions--check with pharmacist
--Do not abruptly stop medication--if stopped, could experience more
seizures
--Pt needs to wear Medic alert band
--HIGHLY BOUND TO PROTEINS- watch for malnutrition = toxicity
* = prototype
Prototype drug for Parkinson's (severe) - CORRECT-ANSWERSCarbidopa-
levodopa
-Significant symptoms/disabilities
, -Increases amount of dopamine concentration
Patient teaching for the patient on medications for Parkinson's - CORRECT-
ANSWERS-Early Adverse effects: pill rolling--thumb and index finger like they
are rolling a pill (or booger), N/V, anorexia, orthostatic hypotension,
dizziness, depresses perspiration, constipation
-Late Adverse effects: Involuntary movements, akinetic spells, anxiety,
depression
U-se w/caution: narrow angle glaucoma, melanoma, GI, heart disease
-Nursing Implications:
Wearing off effect--more pronounced symptoms when at end of dose
Give w/food
Watch protein intake--don't take drug with large amounts of protein
Darkening Urine
Can take weeks to see benefits
Treatment for substance abuse/addiction - CORRECT-ANSWERSdisufiram
(Antabuse)
-used for ETOH addiction
Taper to withdraw from Anxiety meds, sedatives, and hypnotics
Methadone to stop opioid addiction
Naltrexone (Depade, ReVia)---opioid antagonists---used for opioid and ETOH
abuse
Nursing responsibilities for patient on Lithium - CORRECT-ANSWERSAssess
mood
Monitor Na level
Increase fluid intake, monitor use of diuretics
Take w/food
Avoid changes in salt intake
Long term use---doesn't cure, but manages symptoms
8-12 glasses of water a day
--Interacts with SSRIs, alcohol
-blood draws to check level: 0.6-1.2 is therapeutic level. >2 can have
toxicity, >2.5 severe
TCAs - CORRECT-ANSWERSAntidepressants (also given for enuresis aka bed-
wetting)
-amitriptyline hydrochloride (Elavil) and imipramine hydrochloride (Tofranil)
-Adverse: sedation, orthostatic hypotension, dry mouth, urinary retention
-Black Black Warning for adolescents and suicidal idealization
-Do not give concurrently with SSRIs, MAOs
CORRECT ANSWERS
Rank speed of absorption: Po, IM, IV - CORRECT-ANSWERSPo slowest, then
IM, IV fastest
Describe drug distribution in relation to protein binding - CORRECT-
ANSWERSProtein binding- Most drugs form a compound and bind with
plasma proteins. Drug molecules bound to plasma proteins are
pharmacologically inactive. Only the free or unbound portions of the drug
acts on the cells. Protein binding allows for some of the drug to be stored
and others to be released as needed. This gives the constant blood level and
decreased risk for toxicity.
High binding=high duration of action.
Proton pump inhibitors - CORRECT-ANSWERS-Inhibit gastric acid secretions
and prevent pumping of gastric acid from parietal cells
-Drugs in this category:
omeprazole (Prilosec) = prototype; OTC
lansoprazole (Prevacid)
pantoprazole (Protonix) = IV
-Drugs are stronger and more powerful that H2 drugs
-In respects to Tx, pt would try an H2 first before being put on a proton pump
inhibitor
-Drugs are used for erosive gastritis, symptomatic GERDs, stress ulcers (in
ICU pt), H. pylori (bacteria that causes ulcers)
-Drugs have minimal adverse effects, but should be discontinued when pt is
ready to go home
Nursing implications for proton pump inhibitors - CORRECT-ANSWERS-Ulcers
should heal in 4-8 weeks
-If giving pills they should be swallowed whole
-Give before meal/food
Nursing implications for iron - CORRECT-ANSWERS-Take before meals, on
empty stomach (most people can't tolerate this = causes N/V = decrease
effect of drug)
-Take w/full glass of water
-Warn pt of GI upset, iron will make stool black (they aren't bleeding)
,-Drug in liquid form = drink w/straw b/c drug will stain teeth
Reasons for use of the cholinergic drugs - CORRECT-ANSWERSIncrease
bladder tone, relax sphincters. (increased muscle tone allows bladder to
empty)
Side effects of anticholinergic drugs - CORRECT-ANSWERSAtropine:
Tachycardia (from high dose), blurred vision
oxybutynin (Ditropin) & tolterodine (Detrol): dry mouth, constipation, blurred
vision
Benzodiazepines/nursing - CORRECT-ANSWERS**diazepam (Valium),
alprazolam (Xanax), lorazepam (Ativan), midazolam (Versed)**
-Used for sleep, anxiety, preop, and alcohol withdraw
-Adverse effects are oversedations, hangover effect, and decreased
respirations
-Persists for days after discontinued
-Can cause opposite responses in elderly!!!!----excited, aggressive, anxious
-Safety--decreased consciousness---fall risk
-Flumazenil (Romazicon) is the reversal agent
-Give with food, abstain from ETOH, watch OTC medications for sedation
-Taper medication----withdraw will occur if stopped suddenly
-Dependence can occur----short term use only
-"Nerve pills"----taken for anxiety to treat symptoms
phenobarbital (Luminal) - CORRECT-ANSWERSNot used much anymore
Has serious dependence issues and withdrawal
Hangover effect, drowsiness, and suicidal ideation
phenytoin (Dilantin) - CORRECT-ANSWERSSeizures
-Caution: severe kidney/liver disease, elderly
-Careful IV infusion--irritating to veins and painful!
-Give w/food to reduce upset stomach
-Good oral hygiene because of gingival hyperplasia adverse effect
-Generic/trade brands not always same--stay with same brand
-Many medication interactions--check with pharmacist
-Do not abruptly stop medication--if stopped could experience more seizures
Pt needs to wear Medic alert band
dantrolene (Dantrium) - CORRECT-ANSWERSUsed to threat malignant
hyperthermia- runs in families- symptoms occur when exposed to anesthesia
i.e. surgery
Drugs for tx of ADHD - CORRECT-ANSWERSCNS Stimulants (stimulates the
cerebral cortex):
,amphetamine (Adderall), methylphenidate (Ritalin), guanfacine (Intuniv),
atomoxetine (Strattera- new)
-Adverse: can have the opposite effect in children
*concern that ADHD is over diagnosed
-can also be used to treat narcolepsy, weight reduction
-High potential for tolerance- Schedule II
Abortive therapy for migraines - CORRECT-ANSWERStriptans/serotonin
agents
-sumatriptan (Imitrex), zolmitriptan (Zomig)
-Contraindications: CAD, HTN, pregnancy, do not give within 24 hours of
ergot alkaloids
Preventative therapy for migraines - CORRECT-ANSWERS-valporic acid
-gabapentin (Neurotin)
-topiramate (Topamax)
-Beta blockers, calcium channel blockers, TCA
Status epileptus - CORRECT-ANSWERSA seizure that lasts longer than 5
minutes
Patient education/nursing responsibilities for medications for seizures -
CORRECT-ANSWERSphenobarbital (Luminal)--Depress CNS (treat seizures)
--Not used much anymore
--Has serious dependence issues and withdrawal
--Hangover effect, drowsiness, and suicidal ideation
phenytoin (Dilantin)*--stabilizes nerve membranes (10-20mcg/ml therapeutic
range)
--Caution: severe kidney/liver disease, elderly
--Careful IV infusion--irritating to veins and painful!
--Give w/food to reduce upset stomach
--Good oral hygiene because of gingival hyperplasia adverse effect
--Generic/trade brands not always same--stay with same brand
--Many medication interactions--check with pharmacist
--Do not abruptly stop medication--if stopped, could experience more
seizures
--Pt needs to wear Medic alert band
--HIGHLY BOUND TO PROTEINS- watch for malnutrition = toxicity
* = prototype
Prototype drug for Parkinson's (severe) - CORRECT-ANSWERSCarbidopa-
levodopa
-Significant symptoms/disabilities
, -Increases amount of dopamine concentration
Patient teaching for the patient on medications for Parkinson's - CORRECT-
ANSWERS-Early Adverse effects: pill rolling--thumb and index finger like they
are rolling a pill (or booger), N/V, anorexia, orthostatic hypotension,
dizziness, depresses perspiration, constipation
-Late Adverse effects: Involuntary movements, akinetic spells, anxiety,
depression
U-se w/caution: narrow angle glaucoma, melanoma, GI, heart disease
-Nursing Implications:
Wearing off effect--more pronounced symptoms when at end of dose
Give w/food
Watch protein intake--don't take drug with large amounts of protein
Darkening Urine
Can take weeks to see benefits
Treatment for substance abuse/addiction - CORRECT-ANSWERSdisufiram
(Antabuse)
-used for ETOH addiction
Taper to withdraw from Anxiety meds, sedatives, and hypnotics
Methadone to stop opioid addiction
Naltrexone (Depade, ReVia)---opioid antagonists---used for opioid and ETOH
abuse
Nursing responsibilities for patient on Lithium - CORRECT-ANSWERSAssess
mood
Monitor Na level
Increase fluid intake, monitor use of diuretics
Take w/food
Avoid changes in salt intake
Long term use---doesn't cure, but manages symptoms
8-12 glasses of water a day
--Interacts with SSRIs, alcohol
-blood draws to check level: 0.6-1.2 is therapeutic level. >2 can have
toxicity, >2.5 severe
TCAs - CORRECT-ANSWERSAntidepressants (also given for enuresis aka bed-
wetting)
-amitriptyline hydrochloride (Elavil) and imipramine hydrochloride (Tofranil)
-Adverse: sedation, orthostatic hypotension, dry mouth, urinary retention
-Black Black Warning for adolescents and suicidal idealization
-Do not give concurrently with SSRIs, MAOs
