Pharm Final Review Questions and Complete Solutions Graded A+

Pharm Final Review Questions and Complete Solutions Graded A+ a client has anxiety prior to an EGD. The Dr will likely order what class of Meds? - Answer: Benzodiazepine (Benzo) This class of antibiotics is particularly ototoxic. - Answer: Aminoglycosides Monitor this when taking heparin. - Answer: Partial Thromboplastin Time (PTT) Stage when drug is released from its dosage form. - Answer: liberation This class of drug lowers HTN by causing bradycardia - Answer: Beta-Blockers Used to treat Angina - Answer: nitrates Medical term for adipose tissue - Answer: Subcutaneous mg - Answer: milligram female hormone - Answer: Estrogen This class of drugs loweres HTN by reducing volume - Answer: Diuretics time at which insulin has the greatest effects - Answer: peak these block 5-HT receptors to help control N&V - Answer: Serotonin antagonists these laxatives work by drawing water into the stool - Answer: Stool-softeners female clients with multiple sex partners should not solely use this type of contraceptive because it offers no protection aganist STD's - Answer: oral contraceptives This class of antibiotics are the first "true" antibiotics - Answer: Penicillins this drug class lowers gastric acidity by buffering HCI - Answer: antacids Insertion of med between cheek and gums - Answer: buccal clients taking corticosteridos are at risk for this GI complication - Answer: Gastric ulcers Clients with disorganized thinking, changes in affects and delusions or hallucinations have what condition? - Answer: Psychosis codeine, morphine and fentanyl are all in what drug class - Answer: opiate agonist benzodiazepines and hydantions are both classified as - Answer: anticonvuisants insulin should be stored here prior to its first use - Answer: refrigerator inflammation of a vein - Answer: Phlebitis lactic acidosis is a rare but life threatening complication associated with that oral anti-diabetic class - Answer: biguanide can never be mixed with other insulins - Answer: Lantis which route is abbreviated PR? - Answer: rectal Identify and define the four stages all drugs go through once they enter the body. What body systems/organs are involved in each stage? - Answer: Absorption- the process where a drug is transferred from its site of entry into the body to the circulating fluids of the body, (blood and lymph) for the distribution around the body Distribution- the way in which drugs are transported throughout the body by the circulating body fluids to the sites of action or to the receptors that the drug affects Metabolism- the process where the body inactivates drugs.... enzyme systems of the liver are the primary sites for the metabolism of drugs Excretion- the elimination of drug metabolites and in some cases the active drug itself... GI- through feces and Renal tubules- through urine. percutaneous administration - Answer: Applications of medications to the skin or mucous membranes.. primary advantage is it is localized to the site of application which reduces the incidence of systemic side effects. creams, lotions, ointments, powders, mucous membranes-eyes (conjunctival sac, never touch the tip to face or eye), mouth (under tongue or between cheek and teeth, tablet will dissolve and DO NOT administer with water), ear (room temp, children under 3 pull ear down and back over 3 pull ear pull up and back), nose (lie with head back for 2-3 mins after administration), vagina or inhalation of aerosolized liquids or gases Enteral administration - Answer: Drugs administered directly into the GI tract... Disadvantage is its the slowest route and least dependable rate of absorption.. oral (Capsules, timed-released capsules, lozenges or troches, pills, tablets, elixirs, elmulsions, suspensions, syrups), rectal (left sims position), precutaneous endoscopic gastrostomy (PEG) or nasogastric (NG) method (verify placement, flush tube with 30mL of water (room temp)) Parenteral Administration - Answer: intradermal (volumes of 0.01-0.1 mL, 26-28 gauge needle, 15* angle with bevel upward), subcutaneous (subcut) (loose connective tissue between the dermis and muscular layer, no more than 2 mL, 25-29 gauge, 45*-90* angle), intramuscular (IM) (up to 2 mL, 20-22 gauge, 90* angle, will vary on location and size of person), or intavenous (IV) ( ) How do I know my pt is experiencing a drug allergy? Treatment for various types of drug allergy? - Answer: pt could present with hives or have a severe life threatening reactions know at anaphylactic shock. Should carry epipen at all times. 7 right - Answer: 1. patient 2. drug 3. indication 4. route of administration 5. dose 6. time of administration 7. documentation Intramuscular-(IM) - Answer: Give at 90-degree angle; 1 to 1-1/2" length-aspirate to check for blood. If you are mixing medications together be sure they are compatible. Irritating or staining medications may be given using the Z-track method of displacing the skin 1". Do not massage. Deltoid - Answer: 2 finger-widths down from the Acromion process/imaginary line from the axilla. Convenient site for Flu-shots and immunizations on adults and children. Ventrogluteal - Answer: greater trochanter, anterior superior iliac spine and iliac crest. Easily accessible if the pt. is prone, supine or side-lying. Can be used in children over 3, but usually isn't because of the convenience of the thigh muscle. Dorsogluteal - Answer: -z track common here, not used much today due to concern over the sciatic nerve being damaged. Vastus Lateralis- - Answer: one hand below the greater trochanter and one hand above the knee (lateral femoral condyle). injection to the outside of muscle between where hands would be. Preferred IM injection site for infants because it has the largest muscle mass for this age group. Good site for healthy, ambulatory adults and can handle larger volumes of medication. Rectus Femoris- - Answer: same landmarks as VL. We use safer VL, but patients may use for ease of self- administration of injections. Subcutaneous (subcut) - Answer: Insulin, Heparin, Lovenox-0.5-2ml, 90-degree angle- unless thin individual or child then they may need 45 degree angle to keep it from going too deep and being IM instead. Insulin syringes are for insulin only. phlebitis - Answer: inflammation of the walls of a vein thrombophlebitis - Answer: inflammation of the wall of a vein with associated thrombosis, often occurring in the legs during pregnancy. septicemia - Answer: blood poisoning, especially that caused by bacteria or their toxins. infiltration - Answer: the leakage of an IV solution into the tissue that surrounds the vein extravasation - Answer: the leakage of an irritant chemical (medicine being infused) into the tissue that surrounds the vein air embolism - Answer: occurs as a result of an air bubble entering the cardiovascular system pulmonary edema - Answer: caused by infusing fluid to rapidly or by giving to much fluid particularly to older adults and infants or patients with cardiovascular disease pulmonary embolism - Answer: occurs as a result of foreign materials being injected into the vein or from a blood clot that breaks loose and travels to the lungs where it lodges in the arterioles Speed shock - Answer: occurs as a systemic reaction to a foreign substance that is given to rapidly into the bloodstream. this can occur when an IV drug is administered too rapidly into the circulation, most commonly by an IV push. Peripheral Devices - Answer: short term use in the peripheral veins in the hand or arm. Mid-line catheters - Answer: 3-8" long. Inserted at the antecubital fossa into the cephalic or basilic vein and advanced to the axillary vein or distal subclavian vein NOT into the Superior Vena Cava. They are intended for patients needing IV access for 7 days or more. They are often left in place for 2-4 weeks. Central Lines - Answer: (Indwelling catheters)Used for large volumes of medication (chemotherapy),hypertonic solutions such as Total Parenteral Nutrition (TPN);when peripheral sites have been exhausted, or are poor; when long-term home therapy is required or during emergency situations. Central Lines are verified by X-RAY PRIOR to use. PICC's Peripherally inserted central venous catheters- - Answer: inserted into the Superior Vena Cava or just outside the Rt. Atrium, by way of the cephalic or basilar veins of the antecubital space. This provides an alternative to Subclavian or Jugular venous catheterization. These can be inserted at bedside by a qualified nurse. They routinely remain in place for 1-3 months, but with proper care they may remain in place for 12 months (1 year). Tunneled venous catheters - Answer: Inserted by Surgeon with pt. under local anesthesia- 3 common types are Hickman, Groshong and Broviac. You do not need to study differences in them. Implantable infusion Ports - Answer: For long term therapy where intermittent accessing of the central vein is required for administration of IV fluids, medications, TPN, chemo or blood products. Standard access needle is called a Huber needle. They can last longer than a year. Isotonic solutions - Answer: (0.9% Sodium Chloride, Lactated Ringers) ideal replacement fluids for pt. with acute blood loss, GI bleeds or trauma. This type of fluid is used for hypovolemic, hypotensive patients to increase vascular volume to support Blood Pressure. Osmolality is most like blood. Need to monitor for fluid overload (potential pulmonary edema) especially in pt. with congestive heart failure (CHF). Hypertonic solutions - Answer: Higher osmolality than serum. (TPN) Give via Central line where it can be rapidly diluted by the large volume of rapidly flowing blood. Hypotonic solutions - Answer: (0.2% or 0.45 % Sodium Chloride) lower osmolality than serum. This type of solution contains fewer electrolytes and more free water, so the water is rapidly pulled from the vascular compartment into the interstitial and intracellular compartments. Total Parenteral Nutrition (TPN) - Answer: Administration of nutrients directly into the vein. Have to be double checked, do not stop abruptly (hypoglycemia) or sped up (hyperglycemia). Needs administered into a central line because it is hypertonic. If it is not available from the pharmacy and you want to get the question right, hang a new bag of 10% dextrose as ordered. This is the MOST appropriate answer of the choices. List the predictable side effects of anticholinergic agents. Who should not take anticholinergics & why? - Answer: blurred vision, dryness of the mucosa of the mouth, nose and throat, constipation, urinary retention don't give to patients with BPH or closed-angle glaucoma----- Identify classes of drugs which can be used as sedative-hypnotic agents. - Answer: Benzodiazepine What medications are used in the treatment of Parkinsons and Alzheimers? - Answer: Parkinson's--- delegiline (Eldepryl), Siemet (carbidopa, levodopa), entacapone (Comtan), Benztropine mesylate (Cogentin) Alzheimer's--- donepezil (aricept), tacrine (Cognex), mematine (Namenda) Describe classes of drugs which can be used to treat anxiety. - Answer: Benzodiazepine Cite monitoring parameters used for patients taking MAOIs, SSRIs, or SNRIs antidepressants. - Answer: Decrease Termine Diet taper off Identify common adverse effects observed with antipsychotic medications. - Answer: Seizures, weight gain, hyperglycemia, dyslipidemia, dysrhythmias Identify the routes by which seizure medications may be administered. - Answer: oral, IM, IV, rectal opiate agonists - Answer: a group of naturally occurring semi-synthetic and synthetic substances that the ability to relieve sever pain without loss of consciousness. opiate partial agonists - Answer: pharmacologic action is dependent if opiate agonist was administered. If not, partial agonist are effective analgesics. opiate antagonists - Answer: block the effects of opiate agonists. Implement medication therapy health teaching for a patient with angina, who has a prescription for nitroglycerin. - Answer: protect from light and moisture don't take after expiration date Always take medication with you allow tablet to dissolve between cheek and teeth or under tongue take tablets 5 mins apart if pain not relieved. not exceeding more than 3 after 3 tablet go to ER-- DON"T drive yourself, call for ambulance or get a ride What types of meds are used for cough? - Answer: antitussives Hypoglycemia - Answer: clammy skin, shakiness or nervousness, nausea, increased irritability, confusion, dizziness, headache, weakness/fatigue, seizures and unconsciousness Hyperglycemia - Answer: increased thirst/dry mouth, hot, dry, flushed skin, headache, frequent urination, fruity-smelling breath, confusion, coma, and death What medications are used in the treatment of thyroid disease? - Answer: Hypothyroid- levothyroxine (Synthroid) Hyperthroid- propylthiouracil (PTU) Consider neuro meds...any used to treat Alzheimers? Any used to treat combativeness? - Answer: memantine (Namenda) If your patient becomes severely hypoglucemic what will you administer? - Answer: Glucogon What medication suppress the cough center of the brain? - Answer: Antitussives if the patient is receiving loop diuretics what should you watch for? - Answer: hypokalemia how is the hypertonic solution TPN administered? - Answer: through a Central Venous Line what kind of patient should not receive laxatives? - Answer: pt with abdominal pain of unknown origin what is a common side effecdt of antihistamines? - Answer: sedation if your patient is receiving opiate therapy and their respiration become severely lowered what you your administer? - Answer: naloxone (Narcan) you're the nurse on the floor and you have just completed you am med pass. you are working on your documentation when you realize you have administered the wrong medication to one of your patients. what is the first thing that you should do? - Answer: Check on the patient who received the incorrect medications what drug class does proventil (Albuterol) belong to? - Answer: bronchodilator what are some common side effects of bronchodilators? - Answer: restlessness, tachycardia, cardiac palpitations immediately after administering an inhaled corticosteroid to your patient, what should you have the patient do? - Answer: swish their mouth with water the medications donepezil (Aricept) and tacrine (Cognex) are given to patients with Alzheimer's because they do what? - Answer: improve cognitive skills How do nitrates work? - Answer: provided relief of angina by dilating the coronary arteries your patients has acquired Candida Albicans (thrush) of the mouth, how will you treat it? - Answer: liquid antifungal nystatin Which drug class stops gastric secretions? - Answer: proton pump inhibitors what solutions has osmolality similar to blood? - Answer: isotonic TPN is what osmolality? - Answer: hypertonic before administering Digoxin to your patient what should you assess? - Answer: the apical pulse for a FULL 60 secs. Hold med is pulse is below 60 bpm or above 100 bpm what are some side effects of initial Nitrate treatment? - Answer: postural hypotension, flushing of the face, headaches what should the nurse assess prior to the administration of Atenolol? - Answer: heart rate and blood pressure what may happen if you discontinue a patients Beta Blocker suddenly? - Answer: they many have a myocardial infarction (MI) (heart attack) how many mL are in 1oz - Answer: 30mL the altered physical condition caused by the nervous system adapting to drug use is known as? - Answer: physical dependance what medication is given post-op if patient is experiencing N&V? - Answer: ondansetron (Zofran) what might a patient receive to aid in weaning from an opiate dependency? - Answer: methadone (Dolophine) you are a nurse in a long term care facility and one of your residents becomes extremely combative, you have tried to soothe them with non-pharmesuitcial regimines but that does not seem to be working. WEhat medications might your administer? - Answer: Haldol the only first generation anti psychotic what drug class does simvastatin (Zocor) belong to? - Answer: Dyslipidemias In general, transdermal medication patches may be placed where? 1.Upper chest 2.Upper arm 3.Abdomen 4.All of the above - Answer: #4 All are appriopriate The nurse is reviewing orders for a pt admitted to the acute care unit who is allergic to codeine. Which pain mgmt order does the rn question? 1.Methadone 1 tab Q8 hrs prn pain 2.Tylenol #3, 1 tab Q4-6 hrs prn pain 3.Demerol 1 tab Q 3-4 hours prn pain 4.Ibuprofen 600 mg tab Q 6 hrs prn pain - Answer: #2 Tylenol with codeine HMG-CoA reducatse inhibitor drugs are also known by what other name? 1.Nicotinic acid 2.Statins 3.Hypoglycemics 4.Cholesterol potentiators - Answer: #2 statins Rn is teaching a pt about use of nitroglycerin (nitrostat). Which statement by the pt indicates a need for further teaching? 1."Every 2 months the rx should be refilled and the old tabs safely discarded" 2."Nitroglycerin should be stored in it's original container" 3."When taking the drug, I'll feel a slight stinging or burning sensation" 4."I'll swallow my saliva immediately after the tab dissolves" - Answer: #1: Refill every 6 months All others are true (encourage pt not to swallow saliva immediately to get full strength of med at once) Transdermal nitroglycerin patches are often not worn at night why? 1.To prevent tolerance 2.To prevent hypotension 3.They itch when on for longer than 12 hours 3.To avoid medication dependency - Answer: 1. What is the action of fibrinolytic agents? 3.Prevent clotting cascade 3.Prevent thrombus formation 2.Prevent platelet aggregation 1.Dissolve recently formed thrombi - Answer: 4 enoxaparin (Lovenox) may be administered to? 1.A pt s/p hip replacement on bedrest 2.Post-op lap cholecystectomy pt going home that same day 3.Pt with hemoptysis 4.Pt with CVA (stroke) - Answer: 1. a client is prescribed an enema how should the nurse place the client? - Answer: left lateral how does drug distribution occur. - Answer: transporting in blood and lymph systems percutanmeois med adm includes - Answer: sublingual the nurse prepare to give and IM injections the nurse should first - Answer: check the 6 rigths a client developes edema and coolness of a hand in which a PIV is inserted this is most likely what - Answer: infiltration client has been given a nitro pill. a common side effect is - Answer: headache a client is an alcoholic the Dr should avoid what medication class? - Answer: barbituates levodopa is used in the treatment of Parkinson's. once it has been - Answer: a client is prescribed a MAOI this client should avoid - Answer: ble cheese which state dos the nurse include when teaching patients about drug therapy for psychosis - Answer: avoid prolonged exposure to light the patients is allergic to NSAIDs he should not take - Answer: advil a potential SE of loop diuretics is - Answer: hypokalemia a clients has PUD the client may be prescribed a - Answer: coating agent which insulin should be dispersed (rolled) prior to drawing up? - Answer: Humalin NPH Pt is ordered digoxin 600 mcg iv stat. the label reads: digoxin 2mL 500 mcg (0.5 mg) in 2mL. How many mL will you give? 1. 0.24 mL 2. 0.4 mL 3. 2.4 mL 4. 4 mL - Answer: 3. Patients taking potassium sparing diuretics should be instructed to avoid which food? 1.Salt substitutes 2.Chicken 3.Sugar substitutes 4.Milk products - Answer: 1. Which drug is an effective cough suppressant and the standard against which other antitussive agents are compared? 1. Dextromethorphan (Delsym) 2. Acetylcysteine (Mucomyst) 3. Guaifenesin (Robitussin) 4. Codeine - Answer: 4 The rn teaches a pt how to adm 2 puffs of Atrovent via inhalation. The pt performs a return demo. Which action by the pt indicates further teaching is needed? 1.Pt encloses the mouthpiece with lips 2.Pt washes mouthpiece with warm water 3.Pt inhales slowly thru mouthpiece & simultaneously presses the canister once 4.Pt waits 30 seconds and repeats the second inhalation - Answer: #4 wait 1-3 minutes between puffs (pharm book states 10 min, drug book states 1-3 minutes). Atrovent aka ipratropium bromide (anticholinergic). If a bronchodilator is ordered also, take it first to open up airways. Esomeprazole is what type of drug? 1.Antacids 2.H2 antagonists 3.Proton pump inhibitors 4.Antispasmodics - Answer: #3 pantoprazole, lansoprazole, esomeprazole, omeprazole (Protonix, prevacid, nexium, prilosec) Which med is most likely to be prescribed for the pt who is post mi to help prevent constipation or straining at stool? 1.Stool softener 2.Saline laxative 3.Stimulant laxative 4.Bulk forming laxative - Answer: 1. Which drug when taken with insulin is most likely to induce hypoglycemia and/or mask many of the s/s of hypoglycemia? 1.Opioids 2.Ca channel blockers 3.NSAIDS 4.Beta blockers - Answer: 4. What insulin peaks in 2.5-5 hours? 1.Humalog 2.Humulin R 3.Humulin N 4.Lantus - Answer: 2. Pt gets daily injection of 25 units nph at 0700. a hypoglycemic reaction is most likely to occur between what times? 1. 0800 and 1000 2. 1500 and 1800 3. 1900 and 2100 4. 2200 and 2400 - Answer: 2. Which oral antidiabetic class has the potential life threatening complication of lactic acidosis? 1.Sulfonylureas 2.Biguanides 3.Meglitinides 4.Thiazolidinediones - Answer: 2, the drug is metformin/Glucophage. Don't use for pts with decreased renal or liver function, tissue hypoperfusion or people who are getting radiopaque dyes (discontinue use 24-48 hrs prior to getting dye, and don't start for 2-3 days until normal renal function has been proved post dye) Synthroid is used to treat what condition? 1.Anemia 2.N/V 3.Hypothyroidism 4.Hyperthyroidism - Answer: 3. What two types of electrolyte imbalances are corticosteroids most likely to cause? 1.Hyperkalemia and hyponatremia 2.Hypokalemia and hypernatremia 3.Hypercacemia and hypermagnesemia 4.Hypocalcemia and hypomagnesemia - Answer: 2, also cause hypoglycemia. May cause adrenal insufficiency if not d/c'd slowly. Also risk for ulcers if on steroids. patient is taking sulfinouria and is diabetic, what should you watch for - Answer: hypoglycemia which class of anti hypertencies afftects the RASS - Answer: ACE inhibitors tetaclycines dont give to kids for what reason - Answer: stain teeth change IV tubeing to prevent infection - Answer: 72 hours cause rebound congestion- sympathometic - Answer: sudefed thrombloics most frrequent adverse reaction - Answer: bleeding to check route of meds you have to have what - Answer: order ldl 210 hld 40, what drug class will you give - Answer: stain--HMG-COA reducatse inhibitors ortho evra patch - Answer: one weekly for 3 weeks and one week nothing cns DEPRESANT - Answer: DECREADED BREATHING PUD taking sulcarfate when do they want to take - Answer: 1 hr before meals what IV access in used for chemo - Answer: inplanted venous infusion port why dont you crush and extened release tablet - Answer: effects the rate of absorption and delivery pt asks for pain med, but is laughting what do you do? - Answer: ask them to rate pain multiple inhalers pt teaching. - Answer: bronchodilatior first mixing NPH and regular - Answer: air into cloudy (NPH) then air in regular and upp back reg. anpyrective and alangesic affects - Answer: tyelnol blood returns to the heart by what after being oxygening - Answer: by the pulmonary veins pt get humalong at 730, what do you want to make sure is in the room - Answer: their meal pt medication by NG tube what do you do before giving - Answer: Check for palcement anitadote to IV heprin - Answer: protamine sulfate iv sloution leaks - Answer: infiltrated side effects of benzo - Answer: sedtive, drowiseness, oral medication are - Answer: entral ortho evera - Answer: BC patch PUD treated with PPI - Answer: hypylori pt on cumodin cant take aprin because - Answer: interfers with clot formation dr wants the rigth antibiotics to treat what will he do - Answer: cultral and senstive what do you use to treat GERD - Answer: proton pump inhibitos (PPI Zocar (simvastain) used to treat - Answer: dislipidemia dosage is unclear what do you do - Answer: contact dr to clarify aminogly gly, lightheaded, ringing in hears - Answer: ototoxicity genatmysine and - Answer: amino DIg toxicy S&S - Answer: brandcardia, Special precations for drawing up meds from an ample - Answer: use filtered needle domapin antangonist, seritonin angtagins - Answer: nausa and vomiting anti micriboal that are grouped in to generations - Answer: celfasporins durg therpay for pt with parkinson - Answer: restorein doapamine and blocking how does DIG work - Answer: increased for a contraion and force of heart beat when does lantas peak? - Answer: no peak antimicrobails side effects - Answer: iv site is bad and no blood return what do you want to do first? - Answer: stop the infusion laxis needs to be given what labs would you question? - Answer: potass level is 2.5 male= posphade diestrace inhibiter (vigra) should not take with medication? - Answer: nitro levaquin is in what class - Answer: quinalone asprin should be monitered for what toxicity - Answer: sysliciate toxicity pt taking Tums should be montiered for what side effect - Answer: constipation organ responsible for drug metabolism - Answer: liver coumadin antidote - Answer: vitamin K (aquamephyton) when do you take synthroid - Answer: in the moring 30 min before meal S&S barbiturate use - Answer: slurred speech.... prolongs the action of serition - Answer: SSRI class of med that inhances respiratory output - Answer: expectorants Duragesic patches go where (fentanyl) - Answer: upper chest Which drug class, along with cephalosporins has the potential for cross-sensitivity? 1.Penicillins 2.Tetracyclines 3.Quinolones 4.Macrolides - Answer: 1 Clients taking barbituates should avoid: 1.Sleep 2.Exercise 3.Alcohol 4.Glucose intake - Answer: 3 Sinemet is a combination of: 1.Carbidopa & levodopa 2.Carbidopa & apomorphine 3.Levodopa & parlodel 4.Permax & Mirapex - Answer: Answer 1 Levodopa converted to dopamine, carbidopa prolongs action of levodopa Pt is receiving Morphine iv for pain. Pt becomes lethargic, bradypenic, and hypotensive. The antidote to morphine is 1.Narcan 2.Romazicon 3.Neurontin 4.Retrovir - Answer: 1 A client has been prescribed an ssri. The nurse is alert for what adverse reactions to ssris? 1.Restlessness 2.Suicidal tendencies 3.Sedation 4.All of the above - Answer: 4, newer antidepressants are SNRIs (inhibit reuptake of serotonin and norepi), example Cymbalta What labs need monitored when an antipsychotic is administered? 1.CBC & WBC 2.LFTs 3.BUN & Creatinine 4.All of the above - Answer: 4