REAL HESI PHARM Version 1&2 EXAM– Q&A(s)! (I scored 1362!!!)

REAL HESI PHARM Version 1&2 EXAM– Q&A(s)! (I scored 1362!!!) SAMPLE QUESTION/PREVIEW #4 – I put 200 @chrisjay HESI RN PHARMACOLOGY 2022 V2 – (ADDED FEW NOTES) @chrisjay 1. Before administering a laxative to a bedfast client, it is most important for the nurse to perform what assessment? A. Observe the skin integrity of the client's rectal and sacral areas B. assess the client strength in moving and turning in the bed C. evaluate the client's ability to recognize the urge to defecate D. determine the frequency and consistency of bowel movements 2. A female client with multiple sclerosis reports having less fatigue and improved memory since she began using the herbal supplement, ginkgo biloba. Which information is most important for the nurse to include in the teaching plans for this client? A. Aspirin and nonsteroidal anti-inflammatory drugs interact with ginkgo B. nausea and diarrhea can occur when using this supplement C. anxiety and headaches increased with use of ginkgo D. ginkgo biloba use should be limited and not taken during pregnancy @chrisjay 3. In explaining the benefits of the combination anti-infective drug code TMP-SMZ (Bactrim) to a client receiving the medication for a urinary tract infection, more rationale to the nurse provide? A. Each drug could cause damage to the kidneys if taken separately B. One drug reduces the risk of side effects caused by the drug C. while one drug provide relief, the other fights the infection D. the two drugs work together to reduce resistance of the bacterial infection of symptoms 4. Client being treated with Haldol for schizophrenia is complaining of jaw tightness and a stiff neck. Which interventions should the nurse implement? A. give PRN dose of diphenhydramine Benadryl B. assess client other sensory hallucinations C. massage neck until muscles begin to relax D. obtain a 12 lead EKG 5. Which intervention is most important for the nurse implement for a client is receiving Lispro Humalog insulin? A. Check blood glucose levels every six hours B. Provide meals at the same time that insulin is given C. Assess for hypoglycemia between meals D. Keeping oral liquid or glucose source available 6. Client takes nonsteroidal anti-inflammatory drugs every day for rheumatoid arthritis is being treated for anemia which intervention is most important for the nurse to include any plan of care A. Observe for gastrointestinal bleeding B. Monitor liver function test results C. Protect skin from bruising D. Offered dietary selections rich in iron @chrisjay 7. A client receives a prescription for theophylline (Theo-Dur) PO to be initiated in the morning after the dose of theophylline IV is complete. The nurse determines that a theophylline level drawn yesterday was 22 mcg/mL. Based on this information, which action should the nurse implement? A. Hold the theophylline dose and notify the health care provider. B. Start the client on a half-dose of theophylline PO. C. The theophylline dose can be initiated as planned. D. The client is not ready to be weaned from the IV to the PO route 8. The nurse is reviewing a client's laboratory results before a procedure in which a neuromuscular blocking agent is a standing order. Which finding should the nurse report to the health care provider? A. Hypokalemia B. Hyponatremia C. Hypercalcemia D. Hypomagnesemia 9. The nurse is preparing a child for transport to the operating room for an emergency appendectomy. The anesthesiologist prescribes atropine sulfate (Atropine), IM STAT. What is the primary purpose for administering this drug to the child at this time? A. Decrease the oral secretions B. Reduce the child's anxiety C. Potentiate the opioid effects D. Prevent possible peritonitis 10.When caring for a client on digoxin (Lanoxin) therapy, the nurse knows to be alert for digoxin (Lanoxin) toxicity. Which finding would predispose this client to developing digoxin toxicity? A. Low serum sodium level B. High serum sodium level C. Low serum potassium level D. High serum potassium level @chrisjay 11.A client is receiving anti-infective drug therapy for a postoperative infection. Which complaint should alert the nurse to the possibility that the client has contracted a superinfection? A. "My mouth feels sore" B. "I have a headache." C. "My ears feel plugged up." D. "I feel constipated" 12.During the initial nursing assessment history, a client tells the nurse that he is taking tetracycline hydrochloride (Sumycin) for urethritis. Which medication taken concurrently with Sumycin could interfere with its absorption? A. Sucralfate (Carafate) B. Hydrochlorothiazide (Diuril) C. Acetaminophen (Tylenol) D. Phenytoin (Dilantin) 13.Following the administration of sublingual nitroglycerin, which assessment finding indicates that the medication was effective? A. Decrease in level of chest pain B. Clear bilateral breath sounds C. Increase in blood pressure D. Increase in urinary output 14.Alteration of which laboratory finding represents the achievement of a therapeutic goal for heparin administration? A. Prothrombin time (PT) B. Fibrin split products C. Platelet count D. Partial thromboplastin time (PTT) @chrisjay 15.The nurse is assessing a stuporous client in the emergency department whois suspected of overdosing with opioids. Which agent should the nurse prepare to administer if the client becomes comatose? A. Naloxone hydrochloride (Narcan) B. Atropine Sulfate C. Vitamin K D. Romazicon 16.A client with HIV who was recently diagnosed with tuberculosis (TB) asks the nurse, "Why do I need to take all of these medications for TB?" What information should the nurse provide? A. Antiretroviral medications decrease the efficacy of the TB drugs. B. Multiple drugs prevent the development of resistant organisms. C. Duration of the medication regimen is shortened. D. Potential adverse drug reactions are minimized. 17. Two hours after taking the first dose of penicillin, a client arrives at the emergency department complaining of feeling ill, exhibiting hives, having difficulty breathing, and experiencing hypotension. These findings are consistent with which client response that requires immediate action? A. Severe acute anaphylactic response B. Side reaction that should resolve C. Idiosyncratic reaction D. Cumulative drug response 18.Which question should the nurse ask a client prior to the initiation of treatment with IV infusions of gentamicin sulfate (Garamycin)? A. "Are you having difficulty hearing?" B. "Have you ever been diagnosed with cancer?" C. "Do you have any type of diabetes mellitus?" D. "Have you ever had anemia?" @chrisjay 19.A male client who has chronic back pain is on long-term pain medicationmanagement and asks the nurse why his pain relief therapy is not as effective as it was 2 months ago. How should the nurse respond? A. The phenomenon occurs when opiates are used for more than 6 months to relieve pain. B. Withdrawal occurs if the drug is not tapered slowly while being discontinued. C. Pharmacodynamics tolerance requires increased drug levels to achieve the same effect. D. A consistent dosage with around-the-clock administration is the most effective. 20. The nurse is providing discharge instructions to a client who has received a prescription for an antibiotic that is hepatotoxic. Which information should the nurse include in the instructions? A. Avoid ingesting any alcohol or acetaminophen (Tylenol). B. Schedule a follow-up visit for a liver biopsy in 1 month. C. Activities that are strenuous should be avoided. D. Notify the health care provider of any increase in appetite. 21.A client with mild Parkinsonism is started on oral amantadine (Symmetrel). Which statement accurately describes the action of this medication? A. Viral organisms that cause Parkinsonism are eliminated. B. Acetylcholine in the myoneural junction is enhanced. C. Dopamine in the central nervous system is increased. D. Norepinephrine release is reduced within the periphery. @chrisjay 22.A female client who has started long-term corticosteroid therapy tells the nurse that she is careful to take her daily dose at bedtime with a snack ofcrackers and milk. Which is the best response by the nurse? A. Advise the client to take the medication in the morning, rather than at bedtime. B. Teach the client that dairy products should not be taken with her medication. C. Tell the client that absorption is improved when taken on an empty stomach. D. Affirm that the client has a safe and effective routine for taking the medication. 23.A female client with myasthenia gravis is taking a cholinesterase inhibitor and asks the nurse what can be done to remedy her fatigue and difficulty swallowing. What action should the nurse implement? A. Explore a plan for development of coping strategies for the symptoms with the client. B. Explain to the client that the dosage is too high, so she should skip every other dose of medication. C. Advise the client to contact her health care provider because of the development of tolerance to the medication. D. Develop a teaching plan for the client to self-adjust the dose of medication in response to symptoms 24.A female client is receiving tetracycline (Vibramycin) for acne. Which client teaching should the nurse include? A. Oral contraceptives may not be effective. B. Drinking cranberry juice will promote healing. C. Breast tenderness may occur as a side effect. D. The urine will turn a red-orange color. @chrisjay 25.A female client with trichomoniasis (Trichomonas vaginalis) receives a prescription for metronidazole (Flagyl). Which instruction is most important for the nurse to include this client's teaching plan? A. Avoid alcohol consumption. B. Complete the medication regimen. C. Use a barrier contraceptive method. D. Treat partner(s) concurrently. 26.A 2-month-old infant is scheduled to receive the first DPT immunization. What is the preferred injection site to administer this immunization? A. Dorsal gluteal B. Vastus lateralis C. Ventral gluteal D. Deltoid 27. The nurse is evaluating a client's understanding of the prescribed antilipemic drug lovastatin (Mevacor). Which clientstatement indicates that further teaching is needed? A. "My bowel habits should not be affected by this drug." B. "This medication should be taken once a day only." C. "I will still need to follow a low-cholesterol diet." D. "I will take the medication every day before breakfast." 28.An older client who had a colon resection yesterday is receiving a constant dose of hydromorphone (Dilaudid) via a patient-controlled analgesia (PCA) pump. Which assessment finding is most significant and requires that the nurse intervene? A. The client is drowsy and complains of pruritus. B. Pupils are 3 mm; PERRLA. C. The area around the sutures is reddened and swollen. D. Respirations decrease to 14 breaths/min. @chrisjay 29.A client receives an antihypertensive agent daily. Which action is most important for the nurse to implement prior to administering the medication? A. Verify the expiration date. B. Obtain the client's blood pressure. C. Determine the client's history of adverse reactions. D. Review the client's medical record for a change in drug route. 30. The charge nurse is reviewing the admission history and physical data for four clients newly admitted to the unit. Which client is at greatest risk for adverse reactions to medications? A. 30-year-old man with a fracture B. 7-year-old child with an ear infection C. 75-year-old woman with liver disease D. 50-year-old man with an upper respiratory tract infection 31. The health care provider has prescribed a low-molecular-weight heparin, enoxaparin (Lovenox) prefilled syringe, 30 mg/0.3 mL IV every 12 hours, for a client following hip replacement. Prior to administering the first dose, which intervention is most important for the nurse to implement? A. Assess the client's IV site for signs of inflammation. B. Evaluate the client's degree of mobility. C. Instruct the client regarding medication side effects. D. Contact the health care provider to clarify the prescription. 32. The nurse is preparing a plan of care for a client receiving the glucocorticoid methylprednisolone (Solu-Medrol). Which nursing diagnosis reflects a problem related to this medication that should be included in the care plan? A. Ineffective airway clearance B. Risk for infection C. Deficient fluid volume D. Impaired gas exchange @chrisjay 33. The nurse is reviewing prescribed medications with a female client who ispreparing for discharge. The client asks the nurse why the oral dose of anopioid analgesic is higher than the IV dose that she received during hospitalization. Which response is best for the nurse to provide? A. A higher dose of analgesic medication may be needed after discharge. B. An error in the dose calculation may have occurred when the prescribed dose was converted. C. The doses should be the same unless the pain is not well controlled. D. Oral taken drugs dissolves in the gut its not %100 absorbed unlike when it is administered as an IV. (that is the concept of the answer but it is not exactly the same choice). 34.Amoxicillin, 500 mg PO every 8 hours, is prescribed for a client with an infection. The drug is available in a suspension of 125 mg/5 mL. How many milliliters should the nurse administer with each dose? Answer: 20 mL = 500 x 5 / 125 = 20 35. Minocycline (Minocin), 50 mg PO every 8 hours, is prescribed for an adolescent girl diagnosed with acne. The nurse discusses self-care with the client while she is taking the medication. Which teaching points should be included in the discussion? (Select all that apply.) A. Report vaginal itching or discharge. B. Take the medication at 0800, 1500, and 2200 hours. C. Protect skin from natural and artificial ultraviolet light. D. Avoid driving until response to medication is known. E. Take with an antacid tablet to prevent nausea. F. Use a nonhormonal method of contraception if sexually active. @chrisjay 36. The health care provider prescribes carbamazepine (Tegretol) for a child whose tonic-clonic seizures have been poorly controlled. The nurse informs the mother that the child must have blood tests every week. The mother asks why so many blood tests are necessary. Which complication is assessed through frequent laboratory testing that the nurse should explain to this mother? A. Nephrotoxicity B. Ototoxicity C. Myelosuppression D. Hepatotoxicity 37.A 67-year-old client is discharged from the hospital with a prescription for digoxin (Lanoxin), 0.25 mg daily. Which instruction should the nurse include in this client's discharge teaching plan? A. Take the medication in the morning before rising. B. Take and record radial pulse rate daily. C. Expectsome vision changes caused by the medication. D. Increase intake of foods rich in vitamin K. 38.A pediatric client is discharged home with multiple prescriptions for medications. Which information should the nurse provide that is most helpful to the parents when managing the medication regimens? A. Maintain a drug administration record. B. Fill all prescriptions at one pharmacy. C. Allow one person to give the medications. D. Give all medications in small volumes. 39.A 6-year-old child is admitted to the emergency department with status epilepticus. His parents report that his seizure disorder has been managed with phenytoin (Dilantin), 50 mg PO bid, for the past year. Which drug should the nurse plan to administer in the emergency department? A. Phenytoin (Dilantin) B. Diazepam (Valium) C. Phenobarbital (Luminal) D. Carbamazepine (Tegretol) @chrisjay 40.A client who is hypertensive receives a prescription for hydrochlorothiazide (HCTZ). When teaching about the side effects of this drug, which symptoms are most important for the nurse to instruct the client to report? A. Fatigue and muscle weakness B. Anxiety and heart palpitations C. Abdominal cramping and diarrhea D. Confusion and personality changes 41.When providing nursing care for a client receiving pyridostigmine bromide (Mestinon) for myasthenia gravis, which nursing intervention has the highest priority? A. Monitor the client frequently for urinary retention. B. Assess respiratory status and breathe sounds often. C. Monitor blood pressure each shift to screen for hypertension. D. Administer most medications after meals to decrease gastrointestinal irritation. 42.A client is being discharged with a prescription for sulfasalazine (Azulfidine) to treat ulcerative colitis. Which instruction should the nurse provide to this client prior to discharge? A. Maintain good oral hygiene. B. Take the medication 30 minutes before a meal. C. Discontinue use of the drug gradually. D. Drink eight glasses of fluid a day. 43.Which parameter is most important for the nurse to check prior to administering a subcutaneous injection of heparin? A. Heart rate B. Urinary output C. Activated partial thromboplastin time (aPTT) D. Prothrombin time (PT) and international normalized ratio (INR) @chrisjay 44. The nurse plans to draw blood samples for the determination of peak andtrough levels of gentamicin sulfate (Garamycin) in a client receiving IV doses of this medication. When should the nurse plan to obtain the peak level? A. Thirty minutes after the dose is administered B. Immediately before giving the next dose C. When the next electrolyte levels are drawn D. Sixty minutes after the dose is administered 45.A client receiving a continuous infusion of heparin IV starts to hemorrhage from an arterial access site. Which medication should the nurse anticipate administering to prevent further heparin-induced hemorrhaging? A. Vitamin K1 (AquaMEPHYTON) B. Protamine sulfate C. Warfarin sodium (Coumadin) D. Prothrombin 46.A client with acute lymphocytic leukemia is to begin chemotherapy today. The health care provider's prescription specifies that ondansetron (Zofran) is to be administered IV 30 minutes prior to the infusion of cisplatin (Platinol). What is the rationale for administering Zofran prior to the chemotherapy induction? A. Promotion of diuresisto prevent nephrotoxicity B. Reduction or elimination of nausea and vomiting C. Prevention of a secondary hyperuricemia D. Reduction in the risk of an allergic reaction 47. The health care provider prescribes cisplatin (Platinol) to be administered in 5% dextrose and 0.45% normal saline with mannitol (Osmitrol) added. Which assessment parameters would be most helpful to the nurse in evaluating the effectiveness of the Osmitrol therapy? A. Oral temperature B. Blood cultures C. Urine output D. Liver enzyme levels @chrisjay 48.Which factor is most important to ensure compliance when planning toteach a client about a drug regimen? A. Genetics B. Client age C. Client education D. Absorption rate 49.A client being treated for an acute myocardial infarction is to receive the tissue plasminogen activator altaplase (Activase). The nurse would be correct in providing which explanation to the client regarding the purpose of this drug? A. This drug is a nitrate that promotes vasodilation of the coronary arteries. B. This drug is a clot buster that dissolves clots within a coronary artery. C. This drug is a blood thinner that will help prevent the formation of a new clot. D. This drug is a volume expander that improves myocardial perfusion by increasing output. 50. In addition to nitrate therapy, a client is receiving nifedipine (Procardia), 10 mg PO every 6 hours. The nurse should plan to observe for which common side effect of this treatment regimen? A. Hypotension B. Hyperkalemia C. Hypokalemia D. Seizures 51.Dopamine (Intropin) is administered to a client who is hypotensive. Which finding should the nurse identify as a therapeutic response? A. Gain in weight B. Increase in urine output C. Improved gastric motility D. Decrease in blood pressure @chrisjay 52.A client taking linezolid (Zyvox) at home for an infected foot ulcer calls thehome care nurse to report the onset of watery diarrhea. Which intervention should the nurse implement? A. Schedule appointments to obtain blood samples for drug peak and trough levels. B. Reassure the client that this is an expected side effect that will resolve in a few days. C. Instruct the client to obtain a stool specimen to be taken to the laboratory for analysis. D. Advise the client to begin taking an over-the-counter antidiarrheal agent. 53. To evaluate whether the administration of an antihypertensive medication has caused a therapeutic effect, which action should the nurse implement? A. Ask the client about the onset of any dizziness since taking the medication. B. Measure the client's blood pressure while the client is lying, sitting, and then standing. C. Compare the client's blood pressure before and after the client takes the medication. D. Interview the client about any past or recent history of high blood pressure. 54. The nurse is scheduling a client's antibiotic peak and trough levels with the laboratory personnel. What is the best schedule for drawing the trough level? A. Give the dose of medication, and call the laboratory to draw the trough STAT. B. Arrange for the laboratory to draw the trough 1 hour after the dose is given. C. Instruct the laboratory to draw the trough immediately before the next scheduled dose. D. Give the first dose of medication after the laboratory reports that the trough has been drawn. @chrisjay 55. Salicylic acid is prescribed for a client with a diagnosis of psoriasis. Thenurse monitors the client, knowing that which finding indicates the presence of systemic toxicity from this medication? A. tinnitus B. diarrhea C. constipation D. decreased respirations 56. Isotretinoin is prescribed for a client with severe acne. Before administration of this medication, the nurse anticipates that which laboratory test will be prescribed? A. K levels B. triglyceride levels C. Hemoglobin A1C D. total cholesterol level 57.A client with severe acne is seen in the clinic and the HCP prescribes isotretinoin. The nurse reviews the client's medication record and would contact the HCP if the client is also taking which medication? A. digoxin B. phenytoin C. vitamin A D. furosemide 58. The camp nurse asks the children preparing to swim in the lake if they have applied sunscreen. The nurse reminds the children that chemical sunscreens are most effective when applied at which times? A. immediately before swimming B. 5 minutes before exposure to the sun C. immediately before exposure to the sun D. at least 30 minutes before exposure to the sun @chrisjay 59. The nurse is teaching a client how to mix regular insulin and NPH insulin inthe same syringe. Which action, if performed by the client, indicates the need for further teaching? A. withdraws the NPH insulin first B. withdraws the regular insulin first C. injects air into NPH insulin vial first D. injects an amount of air equal to the desired dose of insulin into each vial 60. The home care nurse visits a client recently diagnosed with diabetes mellitus who is taking Humulin NPH insulin daily. The client asks the nurse how to store the unopened vials of insulin. The nurse should tell the client to take which action? A. freeze the insulin B. refrigerate the insulin C. store the insulin in a dark, dry place D. keep the insulin at room temperature 61.A nurse is preparing to administer a dose of warfarin to a patient. Based on the nurse's knowledge of this drug, the nurse knows to monitor for which of the following side effects? A. Black stools B. Constipation C. Abdominal bloating D. Back pain 62.Which of the following is considered a contraindication for administration of Furosemide [Lasix®]? A. 4+ pitting edema in the lower extremities B. Hypertension C. Facial swelling D. Decreased urine output @chrisjay 63.After starting an IV dose of sulfamethoxazole (Bactrim®), the nurse notesthat the patient is having difficulty breathing, his face is flushed, and he complains of back pain. Which type of hypersensitivity reaction is this patient most likely experiencing? A. Cytotoxic B. Serum sickness C. Anaphylactic D. Infectious 64.A nurse is caring for a pregnant patient who needs treatment for rosacea. The patient asks the nurse about using topical corticosteroids for treatment. Which of the following information should the nurse provide this patient? A. The patient can safely use this type of medication B. The patient can only use this medication in areas away from the abdomen C. This medication causes teratogenic effects and should be avoided D. There is no safety evidence of this medication during pregnancy, so it should be avoided 65. Which of the following agents would increase sedation caused by morphine? A. ethanol B. diazepam C. chlorpromazine D. clomipramine E. All of the above @chrisjay Important points that you must know Nitroglycerine Vasodilator to reduce angina by increasing blood oxygen to the heart and by decreasing its work load. Vasodilation lowers the BP. Give break at night for 8 hours, then apply new in morning; rotate sites. If irregular angina occurs follow steps for NTG, 3 times, every 5 minutes, call 911, etc. Peak Levels Drawn 30 minutes after a medication is given IV or 1-2 hours after it is given orally Trough Levels Drawn 30 minutes before medication is given. Transdermal Fentanyl patch Applied once every 72 hours. Given for opioid tolerant patients. Never apply heat to patch and always remove previous patch. Orlistat (Xenical) Unabsorbed fat causes oily/fatty stool, diarrhea, and flatulence. Psychotropic drugs and grief teaching Support groups and collaborative grief care; make sure pt. adheres to medication. Lithium therapeutic values in blood 0.6 - 1.8 mg/dL Pilocarpine Cholinergic miotic; used as a miotic in the treatment of glaucoma to increase aqueous fluid outflow. Side Effects = decreased visual acuity, especially in dim light; other side effects include transient burning/discomfort, blurred vision, pain, photophobia, lacrimation. @chrisjay Muscarinic Drugs/ Anticholinergic Adverse Effects = blurred vision, worsening of angle-closure glaucoma, dry mouth, tachycardia, constipation, urinary retention, and decreased sweating Reduce overactive bladder contractions in urge urinary incontinence and overactive bladder Bactrim First choice drugs to treat uncomplicated or initial UTI. Used prophylactically to prevent UTI in transplant. Adverse Effects = hemolytic and aplastic anemia, agranulocytosis, thrombocytopenia, photosensitivity, exfoliative dermatitis, Steven-Johnson syndrome, neutropenia etc. Also nausea/vomit/diarrhea, nephrotoxicity, HA, peripheral pruritus, cough, etc. May interact with oral contraceptives; reduces effects. Patient Controlled Analgesia Pump Used only by patients to help prevent addiction and promote self-management of care; also prevents accidental overdose. Continue monitoring respiratory status Dilantin Side effect= Gingival hyperplasia is long term of phenytoin use; therapeutic levels of Dilantin are 10-20 mg/dL Tylenol overdose No more than 3000 mg/day for adults; patients who are hepatically compromised should not take more than 2000 mg/day Epivir for HIV (nucleoside reverse transcriptase inhibitors) Prevent viral reproduction and are also used in the treatment of chronic HBV when evidence of replication is present. Reduces viral load, decreases liver damage, and liver enzymes Ketorolac (Toradol) @chrisjay NSAID and used because it is the most powerful in its drug classification; usedshort-term for moderate to severe pain. Main side effect= renal impairment, edema, GI pain, dyspepsia, and nausea Lactulose Given in cirrhosis to counteract effects of ammonia buildup which has severe neurological manifestations. Binds to ammonia and is excreted in stools. Evaluate pt. LOC and neurologic status to determine effectiveness of therapy. Glucagon Emergency Kit Stimulates glycogenolysis and gluconeogenesis; used to treat hypoglycemia if patient becomes unresponsive. Instruct family when and how to use; in emergency it is given as 1 mg by IM or SQ when Dextrose 50% cannot be given. To prevent aspiration if vomiting occurs (common side effect of glucagon), turn patient on side until they become alert. Byetta Indicated only for Type II diabetes patients who have been unable to achieve blood glucose control with metformin, or glitazone and cannot be used with insulin; best given 60 minutes before a meal. Side effect = nausea/vomit/diarrhea, and some patients may experience weight loss of 5-10 pounds. Labetalol Beta blocker used to manage HTN. Labetalol and other beta blockers have major impacts on cardiac and respiratory systems. Side effects includes weight gain so monitor and assess I &O and daily weights associated with pulmonary edema especially if the pt. has diabetes. Lasix Decreases reabsorption of Na and water; is a loop diuretic. Can cause fluids and electrolytes imbalances such as hypokalemia, hyperglycemia, hyperuricemia which can lead to cramps, especially hypokalemia. @chrisjay Dopamine IV infiltration When the drugs move into the tissues surrounding the infusion site causing local tissue damage; cardinal sign of infiltration is pain but also includes pain, swelling, redness, and vesicles on the skin. Immediately turn off the infusion and intervene to prevent further complications Digoxin Toxicity Improves myocardial contractility and reduces HR; used mostly in heart failure. Therapeutic index is 0.5-2.0 mg/dL and treatment of toxicity consists of withholding drug and giving the antidote (Digibind). Monitor for signs of hypo and hyperkalemia, these can increase or decrease effects of digoxin Early signs of toxicity include n/v, anorexia, fatigue, HA, depression, and visual changes (halos, bright lights) Late signs of toxicity include dysrhythmias (bradycardia and AV block) Coumadin (Warfarin) precautions Interferes with hepatic synthesis of vitamin K dependent clotting factors; is an anticoagulant Check pt. BP, monitor for bleeding, takes 3-5 days to be active or show effects; know INR and monitor blood values (platelets); Vit K is antidote. Do not give antiplatelet or NSAIDs with warfarin Baclofen A muscle relaxer and an antispastic agent and can be used for multiple sclerosis, muscle spasms, pain, and stiffness. Side effects= include seizures (convulsions), confusion, hallucinations, or an irregular heartbeat. Other less serious side effects include drowsiness, dizziness, weakness, HA, insomnia, nausea, constipation, and frequent urination. Bulk forming laxative Psyllium (Metamucil, Naturacil); high fiber content absorbs water and increases solid intestinal bulk, stimulate peristalsis. @chrisjay Must be mixed and taken with at least 240 mL of water or juice and swallowedquickly, and follow with water. Boniva Treats osteoporosis. Side Effects: mild flu like symptoms, vision changes, heartburn, chest pain, blood in stool and vomit. Dilaudid Side Effects: dizziness, drowsiness, sedation, hypotension, bradycardia/tachycardia, NVC, resp. depression Steroids Do not stop taking abruptly, they must be weaned off. Patient is at risk for hypoadrenal crisis (shock and circulatory collapse) if stopped abruptly. Vitamin D overdose Most common in children. Discontinue use / calcium intake reverses toxic effects Aricept Alzheimer’s medication used to slow progression and improve quality of life. Do not cure Accutane Acne drug that causes birth defects (abnormalities of the skull, face, ears, eyes) and spontaneous abortions. Patients should be on two contraception methods. Sun exposure should be avoided. No longer on the market due to suicides. Levothyroxine (Synthroid) overdose Monitor HR, report pulse > 100 bpm, or an irregular heartbeat; promptly report chest pain, weight loss, nervousness, tremors, and /or insomnia. May take up to 8 weeks before full effect of hormone therapy is seen so don't overdose; monitor SE before increasing dosage. @chrisjay Intranasal anti-diuretic hormone (Desmopressin) Used to control polydipsia (excessive thirst), polyuria, and dehydration in patients with DI. Intranasal form can have unpredictable absorption, so contact HCP if condition worsens. Pump needs to be primed prior to administration. 10 mcg per pump is the dose. If more needs to be given, it needs to be split between nostrils Vasopressin nasal is used topically to nasal membranes and must not be inhaled; Desmopressin is given via nasal pump. These meds should be used with caution in patients with seizure disorders, asthma, CVD, and renal disease Prevacid Used with GERD. Decreases the amt. of acid in the stomach and helps heal acid damage. OTC can treat frequent heartburn. Takes 2-7 days for full effect. Tigan Used post op to treat/prevent N/V. Monitor fluid and electrolytes along with BP, HR, and respirations. Side Effects= include diarrhea, HA, dizziness, drowsiness, muscle cramps; rare SE include confusion, muscle spasms, uncontrolled movements, tremor, mouth sores, unusual bleeding, seizures, mental mood changes, depression, yellowing of the eyes, and dark urine Anti-tussive Given to suppress coughing (only given in non-productive coughs or after abdominal surgery) Side Effects = dizziness, HA, nausea, sedation, drowsiness, constipation Perform respiratory assessment and allergy assessment before administering. Monitor for therapeutic responses Rifampin Antibiotic used for TB. Can color urine red-orange. Reduces effectiveness of birth control @chrisjay Theophylline Mehtylxanthine used in COPD patients as a bronchodilator; half-life is decreased by smoking and increased by HF and liver disease Signs of toxicity include nausea, vomiting, seizures, and insomnia Avoid caffeine to prevent intensifying adverse effects Monitor serum blood levels regularly to determine drug is in therapeutic range (10-20 mcg/mL) Garamycin Aminoglycoside antibiotic. Can cause toxicities to renal system and ears. Pilocarpine Used as a miotic in the treatment of glaucoma to increase aqueous fluid outflow Side Effects = warn pt. about decreased visual acuity, especially in dim light; other side effects include transient burning/discomfort, blurred vision, pain, photophobia, lacrimation, iritis Abilify (Aripiprazole) Anti-psychotic used to treat schizophrenia, bipolar, major depression, tics, and irritability of autism. Commercial promotion has increased inappropriate use for anxiety Lamisil (Terbinafine) Antifungal that is contraindicated with renal and kidney failure Exelon Transdermal patch for dementia, Alzheimer’s & Parkinson’s. Adverse Effects: nausea, bloody vomit & stool, confusion, tremors, chest pain, burning urination Amiodarone Potassium channel blocker / anti-dysrhythmia. Ventricular tachycardia and ventricular fibrillation @chrisjay Nasal inhaler use Shake well. Pt should be sitting upright. Have pt hold one nostril shut while inhaling it into opposite nostril. Pt needs to sit supine for 5 min them repeat as ordered Nasogastric Tube administration Fowler’s position. Double check tube. Crush and mix or use liquid medication. Administer one drug at a time, flushing with 10ml of water between and 30 mL after last dose Singulair Long term treatment for prevent asthma in adults and kids >12. Given once daily in the evening. Tetracycline Antibiotic. Avoid sun. Use probiotic to counter side effects. Finish all the medication. Effects can start immediately and last several days after discontinuation Tyramine INH / anti-tubercular medication. Avoid foods that contain tyramine (aged cheese, red wine, preserved meat). Causes hypertensive crisis. Herbal Gingko biloba Helps with cognitive dysfunction due to anti-inflammatory and platelet activation factor inhibiting properties. Used for memory loss, peripheral artery occlusive disease, and tinnitus Aldactone (Spironolactone) Potassium sparing diuretic. Used for severe heart failure. SE: gynecomastia, testicular atrophy, hirsutism. Avoid foods high in potassium Spiriva (Tiotropium) @chrisjay Used with COPD. Inhaler. Anticholinergic that bronchodilators. Prevents spasms.Used to prevent, will not work if attack is already happening. Vancomycin peak & trough Peak - 18-50 Trough - 10-20 Xenical (orlistat) Protein bound drug that inhibits fat absorption. Causes diarrhea, fatty stool, and flatulence. Uses for weight loss Calcium channel blockers Reduce electrical conduction w/in the heart which decreased the force of the contraction and dilates the arteries. Dilation of the arteries increases oxygen to the heart while the reduced contractions decrease the demand for oxygen by the heart muscle. Used for angina, HTN, abnormal heart rhythms. Crestor/Lipitor Antilipemic used for the reduction of LDL's and triglycerides while increasing HDL's. No pregnant women Eliquis/Enoxaparin Anticoagulants that causes increased bleeding. Tarry stool is indicative of internal bleeding and the doctor needs to be contacted immediately Labetalol Beta adrenergic blocker for HTN. Reduces HR/BP, force of contraction and conduction Zipsor (diclofenac) NSAID for acute and chronic RA / osteoarthritis. Risks include CHF, MI, stroke, hepatotoxicity, bronchospasm, and anaphylaxis Lantus(Glargine) Long acting insulin that has no peak. @chrisjay Victoza (Liraglutide) Non-insulin treatment for obese patient with type II diabetes Calcitriol (Miacalcin) Synthetic vit. D for hypocalcemia. Patients with chronic renal failure in dialysis. Also used as supplemental vitamin D for thyroid issues Lactulose Laxative used to reduce blood ammonia levels. Monitor serum electrolytes. Can raise blood glucose levels in diabetics Reglan (Metoclopramide) Used for GERD. Black box warning for rhythmic involuntary movements (tremors). Notify MD immediately as effect can sometime be irreversible Flu vaccination Single most important influenza control. Each vaccine contains 3 strains based on recent outbreak data. Effectiveness varies with age, immunocompromised status of patient, and similarity to strains occurring during season Videx (Didanosine) Immunosuppressant therapy raises risk for infection. AIDS medication Plavix (clopidogrel) Hold prior to surgery to reduce risk of bleeding out Epogen Anti-anemic raises rate of RBC production. Teach patients how to take BP, take iron/B12/folic acid. No hazardous activities or driving Gengraf Grapefruit increases absorption of the drug causing toxicity Echinacea @chrisjay OTC ViraMedx. Herbal remedy used for treating cold sores. Antiseptic action, doesnot kill virus Actonel Bisphosphonate for osteoporosis and Paget’s. Increases bone mass. Take with plain waiter at least 30 minutes before first food or drink of the day. Do not lie down for 30 minutes Celebrex Decreases pain and inflammation caused by RA and osteoarthritis Clonazepam (Klonopin) Anticonvulsant used for various types as well as panic disorders. Monitor for suicidal thoughts or behavioral changes Duragesic patches Opioid, fentanyl patch, pain relief Nubain Synthetic opioid antagonist analgesic. Watch for resp. depression, bradycardia, sedation, euphoria, hallucinations St John’s wort Herbal for mild depression, anxiety, OCD. Do not take with antidepressants, opioids, liver medications, or transplant medications Zovirax (acyclovir) Antiviral used to treat herpes and varicella infections. Reduces severity and healing time. Watch for sore throat, fever, fatigue - could indicate superinfection Mydriatics Drugs that dilate pupils. Used for chronic open angle glaucoma and ocular HTN Flagyl @chrisjay Antimicrobial agent used to treat Clostridium difficile. acute interaction with alcohol or alcohol containing products (cough med) causing severe vomiting. No alcohol 24 hours before or 36 hours after taking the medication Ativan Used for delirium tremens. Benzos are the #1 choice for alcohol withdrawal and delirium tremens. Antidepressants & addiction Generally considered non addictive however some such as Prozac and Xanax can be highly addictive Adderall Should be timed for periods when symptoms control is needed most. Last dose should be taken 4-6 hours before bedtime. Exelon side effects Transdermal patch - for dementia (Alzheimer’s/ Parkinson’s) AE -Nausea and bloody vomit, bloody stool, confusion, tremors, chest pain, burning urination Amiodarone Potassium Channel Blocker - lowers BP and HR Antidysrhythmic (most successful) – Ventricular tachycardia & Ventricular fibrillation Lipophilic Adverse Effects: pulmonary toxicity, eyes (dry, photophobia, halos) Drug Interactions: with Warfarin and Digoxin (increases toxicity) Do not give for severe bradycardia Nasal inhaler use @chrisjay Shake well Upright client holds one nostril closed while inhaling and squeezing into opposite nostril Maintain patient in supine for 5 min then repeat as ordered NGT Med Administration Have patient upright in Fowler position Double check placement of tube Crush and mix or use liquid medication Administer one drug at a time flushing with 10ml of water between and 30 ml after last dose Montelukast (Singulair) Administration Time Long-term treatment of asthma in adults and kids >12-years-old Once daily in evening time Tetracycline teaching Antibiotic Avoid sun Use probiotics to counter side effects (diarrhea) Finish all medication Effects can start immediately and last several days after discontinuation Math - IM med administration mg/ mL - milligrams per milliliter used for liquid, suspension IM sites (ventro glut (preferred), vastus lateralis (infants), and deltoid Z-track for irritating meds (Iron) @chrisjay INH (isoniazid) and Tyramine Antituberculosis drug Tyramine in foods should be avoided (aged cheese, red wine, preserved meats) causes hypertensive crisis Multiple Sclerosis and Herbal Gingko Ginkgo can help with cognitive dysfunction due to anti-inflammatory and platelet activation factor inhibiting properties Ginkgo is for memory loss, peripheral artery occlusive disease and tinnitus Spironolactone (Aldactone) Potassium sparing diuretic and aldosterone antagonist Used for severe heart failure Has greatest antihypertensive benefits (compared to others of same class) Side Effects: gynecomastia, testicular atrophy, hirsutism Adverse Effects: Hyperkalemia (avoid K+ rich foods while taking) Oxybutynin (Ditropan) side effects Anti-cholinergic -Used to treat overactive bladder Anti-SLUDGE Side Effects - dry mouth, constipation, and vision (dry eyes, blurred vision, halos) Avoid overheating outdoors (reduces sweating) Spiriva (Tiotropium) for COPD Inhaler used with tablet (not oral) Anticholinergic – bronchodilators Prevents bronchospasms - used to prevent, will not reverse attack once it occurs @chrisjay Vancomycin - Peak/Trough Peak 18-50 mcg/mL Trough - 10-20 mcg/mL Low dosage = reduced antibacterial effect High dosage = ototoxicity and nephrotoxicity Xenical (orlistat) Weight management Protein bound drug that inhibits fat absorption Causes: diarrhea, fatty stool, flatulence Baclofen - teaching Skeletal muscle relaxant/ antispasmodic for Multiple Sclerosis Avoid activities that require alertness (driving) Do not stop taking abruptly - withdrawal occurs Calcium Channel Blockers (verapamil, amlodipine, diltiazem, nifedipine) Reduce electrical conduction within heart decreasing force of contraction and dilate arteries Dilation of arteries increases oxygen to heart while reduced contraction decrease demand for oxygen by heart muscle Uses - angina, hypertension, abnormal heart rhythms Side Effects - edema, impotence Crestor (rosuvastatin) Evaluate effects Antilipidemia - used for reducing LDL's and triglycerides while increasing HDL's Not for use in pregnant women (Category X) @chrisjay Digoxin toxicity signs and symptoms Life-threatening heart rhythms, appetite loss, abdominal discomfort, blurred vision, mental changes, hypokalemia Effient (Prasugrel) and tarry stool Anticoagulant - causes increased bleeding Tarry stool is indicative of internal bleeding and doctor needs to be contacted immediately Labetalol (Trandate) Beta adrenergic blocker for hypertension Reduces HR, Force of Contraction and Conduction, BP Zipsor (diclofenac potassium) -risks NSAID for acute and chronic RA, Osteoarthritis Risks include CHF, MI, stroke, hepatotoxicity, blood dyscrasias, bronchospasm and anaphylaxis Lantus (insulin glargine) - peak Long acting insulin that has no peak. Synthroid overdose signs Cardiac dysrhythmias - can be fatal Tachycardia, palpitations, angina, tremors Victoza (Liraglutide) - Type II Diabetes Non-insulin treatment for Type II only May lower blood sugar if used with diet and exercise measures Daily injection @chrisjay Calcitriol (Miacalcin) Synthetic vitamin D for hypocalcemia for patient with chronic renal failure in dialysis Also used as supplemental vitamin D for hypoparathyroidism, pseudohypoparathyroidism, hypophosphatemia, hypocalcemia infants Aspirin and NSAID caution Do not take together NSAIDS can decrease antiplatelet effects of aspirin. Always look for signs of GI bleeding Lactulose - What to evaluate Hyper-osmotic laxative to reduce blood ammonia levels Monitor serum electrolytes In diabetics it can raise blood sugar If there is a liver problem and jaundice, look for signs of improvement as increase level of consciousness. Reglan (metoclopramide) and tremors Used for GERD for short term therapy. Black box warning for rhythmic involuntary movements (extrapyramidal): Notify MD immediately as effect can sometime be irreversible Flu Vaccine Single most important influenza control Each vaccine contains 3 strains based on recent outbreak data Effectiveness varies with age, immunocompromised status of patient, and similarity to strains occurring during season AIDS/ Videx (Didanosine) risk of infection @chrisjay Immunosuppressant therapy raises risk for infection Plavix (clopidogrel)- hold Anticoagulation so HOLD prior to surgery to reduce risk of bleeding out Epogen - instructions Antianemia - raises rate of RBC production Teach the patients how to take BP, take iron, B12, folic acid No hazardous activities or driving Gengraf (cyclosporine) and grapefruit Increases absorption of drug causing toxicity Echinacea -topical OTC ViraMedx Herbal remedy used for treating cold sores Antiseptic action, does not kill virus Actonel (Risedronic acid) Administration Bisphosphonate for osteoporosis and Paget’s Increases bone mass Take with plain water at least 30 min before firs food or drink of day. Do not lie down for 30 minutes Celebrex (Celecoxib) desired effect Decrease pain and inflammation caused by Rheumatoid arthritis and osteoarthritis @chrisjay Clonazepam (Klonopin) Anticonvulsant Used for various seizure types as well as panic disorder Monitor for suicidal thoughts or behavioral changes Duragesic (Fentanyl) Opioid Fentanyl patch Pain relief Nubain (Nalbuphine) adverse effects Synthetic opioid agonist analgesic Respiratory depression, bradycardia, sedation, euphoria, hallucinations Toradol (ketorolac) side effects NSAID Pain and inflammation reduction post-surgery Adverse Effects -bleeding, hypovolemia seizures, CV thrombolytic events hepatic failure and renal disease Avoid during pregnancy St John’s Wort Herbal for mild depression and anxiety, OCD Do Not Take with antidepressants, opioids, liver medications or transplant medications Zovirax (acyclovir) and STI Antiviral used to treat Herpes and varicella infections Reduces severity and healing time @chrisjay Watch for sore throat, fever, fatigue - could indicate superinfection Viagra (sildenafil) Vasodilation to increase blood flow to certain areas Not recommended for patients with heart issues Can cause hypotensive effects in patients on nitrates (contraindicated and if the patient is on both, should go to the ER) Antihistamine action Blocks histamine receptors which prevents the release and actions of histamine. Does not push off already attached histamine; therefore, more beneficial if given early Cross sensitivity for respiratory drugs Beta agonists (non-selective) effect both beta 1 and 2 receptors which causes both bronchiole constriction and vasoconstriction Not indicated for asthma patients Long term glucocorticoids Adrenal drugs that mimic corticosteroids Long term use may lead to decreased wound healing, moon face, hyperglycemia, psychosis and Cushing’s Mydriatics drugs Drugs that dilate pupils. Used for chronic open angle glaucoma and ocular hypertension Sympathomimetic (mimic SNS) @chrisjay Accutane (Isotretionin) and sun toxicity Treats severe acne by inhibiting sebaceous glands Sun exposure should be avoided as it can cause toxicity Currently off market due to suicides Flagyl (metronidazole) - C diff - teaching Antimicrobial agent used to treat Clostridium difficile Acute interaction with alcohol or alcohol containing products (cough med) causing severe vomiting No alcohol 24 hours before taking or 36 after taking Nexium and NSAID therapy Nexium (antacid) and NSAIDS cause GI irritation Ativan (lorazepam) for delirium tremens Benzos are #1 choice for alcohol withdrawal and delirium tremens Adderall (amphetamine and dextroamphetamine) and time of dosage For ADHD Should be timed for periods when symptoms control is needed most. Last dose should be taken 4-6 hours before bedtime. Antidepressants and addiction Generally considered non addictive however some such as Prozac and Xanax can be highly addictive