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109 Cards in this Set
- Front
- Back
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A patient is receiving a local anesthetic before a procedure. The basic mechanism by which this agent acts is:
A. synaptic transmission. B. decreased transmitter release. C. axonal conduction. D. increased receptor binding. |
Answer: C
Rationale: A local anesthetic will alter axonal conduction. |
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A patient is prescribed a drug that causes selective stimulation of beta2 receptors. The nurse will assess for:
A. hypoglycemia. B. improved breathing. C. tachycardia. D. decreased pain. |
Answer: B
Rationale: Beta2 stimulation will result in bronchial dilation and hyperglycemia. |
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A drug that stimulates the sympathetic nervous system would result in:
A. increased heart rate. B. decreased blood pressure. C. bronchial constriction. D. hypoglycemia. |
Answer: A
Rationale: Sympathetic nervous system activation results in increased heart rate and blood pressure, bronchial dilation, and increased blood glucose levels. |
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A nurse administers dopamine to a patient. What receptors will be activated other than the dopamine receptors?
A. Alpha2 and beta2 receptors B. Alpha1 and beta1 receptors C. No other receptors will be activated D. Alpha1 and beta2 receptors |
Answer: B
Rationale: Dopamine can activate alpha1, beta1, and dopamine receptors. |
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A patient is prescribed bethanechol for urinary retention. If the
patient exhibits signs of an overdose (increased salivation and sweating, bradycardia, and hypotension), the nurse will administer: A. physostigmine. B. acetylcholine. C. cholinesterase inhibitor. D. atropine. |
Answer: D
Rationale: Atropine is a selective muscarinic blocking agent and will reverse most signs of toxicity. |
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A patient who takes oxybutynin for an overactive bladder takes an over-the-counter antihistamine for hay fever symptoms. What symptoms should the nurse watch for that would indicate toxicity?
A. Cool, moist skin; confusion; and bradycardia B. Dry mouth, increased temperature, and blurred vision C. Hallucinations, increased salivation, and diaphoresis D. Hypothermia, increased respiratory rate, and pupil constriction |
Answer: B
Rationale: Symptoms of muscarinic antagonist toxicity include dry mouth; blurred vision; photophobia; hyperthermia; respiratory depression; and hot, dry, and flushed skin. |
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A patient with myasthenia gravis is prescribed neostigmine
(Prostigmin). Which of the following will the nurse include patient teaching? A. The medication is an irreversible cholinesterase inhibitor that may cause a cholinergic crisis. B. An extra dose should be administered if the patient feels extreme weakness or muscle paralysis. C. The patient should wear medical identification to alert medical personnel of the condition. D. The condition is curable, and the medication will be taken for 2 to 3 months. |
Answer: C
Rationale: Neostigmine (Prostigmin) is a reversible cholinesterase inhibitor. Emergency medical assistance should be attained for symptoms of weakness or muscle paralysis to determine whether the episode is a myasthenic or cholinergic crisis. The condition is not curable. A medical identification should be worn by the patient to alert medical personnel of the condition because both types of crises can be fatal. |
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A patient asks the nurse the indications for a newly prescribed
medication, echothiophate (Phospholine Iodide). The nurse tells the patient the medication will treat: A. muscle weakness and fatigue. B. dementia from Alzheimer’s disease. C. neuromuscular blockade toxicity. D. increased intraocular pressure. |
Answer: D
Rationale: Echothiophate (Phospholine Iodide) is an irreversible cholinesterase inhibitor used to treat glaucoma (increased intraocular pressure). |
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When administering a neuromuscular blocking agent to an alert patient before a procedure, the nurse should:
A. teach the patient relaxation exercises. B. administer a sedating agent. C. assess for the presence of a gag reflex. D. check for allergies to the aminoglycosides. |
Answer: B
Rationale: Neuromuscular blockers do not diminish consciousness or perception of pain even with complete paralysis. |
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A nurse is preparing a neuromuscular blocking agent to be used for endotracheal intubation. The drug most often used is:
A. tubocurarine. B. pancuronium. C. succinylcholine (Anectine). D. vecuronium (Norcuron). |
Answer: C
Rationale: Succinylcholine is the preferred agent for endotracheal intubation because of its short duration of action. |
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After an intramuscular injection of penicillin, the patient develops severe difficulty breathing and a swollen tongue. The nurse will prepare to administer:
A. dopamine. B. epinephrine. C. isoproterenol. D. phenylephrine. |
Answer: B
Rationale: Epinephrine is the drug of choice for patients in anaphylactic shock. |
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A patient is receiving dopamine for treatment of shock. What parameter offers the best indicator of improved clinical status?
A. Mean arterial pressure B. Daily weight C. Systemic venous resistance D. Urine output |
Answer: D
Rationale: Dopamine is used in the treatment of shock. Improved clinical status will best be monitored by the urine output. Dopamine will dilate renal blood vessels and improve renal perfusion and increase urine output. |
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A patient is receiving a drug that blocks adrenergic receptors. The most serious adverse response to this drug is:
A. nasal congestion. B. orthostatic hypotension. C. inhibition of ejaculation. D. reflex tachycardia. |
Answer: B
Rationale: Orthostatic hypotension can reduce blood flow to the brain, causing dizziness, lightheadedness, and syncope. |
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A patient with diabetes requires a beta blocker. Which of the following drugs would be appropriate for this patient?
A. Propranolol B. Atenolol C. Carvedilol D. Terazosin |
Answer: B
Rationale: Patients with diabetes who are prescribed beta blockers should receive a beta1 selective agent such as atenolol. Propranolol blocks both beta1 and beta2 receptors; carvedilol blocks beta1, beta2, and alpha1 receptors. Terazosin is an alpha1 receptor blocker. |
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A patient is prescribed reserpine. What patient response indicates the medication has produced an adverse effect?
A. Tachycardia B. Elevated blood pressure C. Depression D. Constipation |
Answer: C
Rationale: Reserpine can produce severe depression, orthostatic hypotension, bradycardia, gastric ulcerations, cramping, and diarrhea. |
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A patient plans to stop taking prescribed clonidine to treat
hypertension because of dry mouth. The nurse should: A. tell the patient that dry mouth is not an adverse effect of clonidine. B. give the patient hard candy to suck on to relieve the symptom. C. instruct the patient to stop taking the medication immediately. D. allow the patient to take a reduced dose of the medication. |
Answer: B
Rationale: Dry mouth (xerostomia) is common in patients taking clonidine and is usually temporary (lasting only 2 to 4 weeks). The patient should be instructed to chew gum, suck on hard candy, or take frequent sips of fluids to provide relief of the dry mouth. |
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Why would oral administration generally be preferable to parenteral administration?
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ease, convenience and relative safety.
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Can you think of situations in which parenteral administration might be superior?
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Emergencies that require rapid onset
Situations in which plasma drug levels must be tightly controlled. (Oral admin does not permit tight control of drug levels because of variable absorption.) Need for drugs which would be destroyed by gastric acidity, digestive enzymes or hepatic enzymes if given orally (insulin, penicillin, nitroglycerin). Treatment with drugs that would cause severe local injury if administered by mouth (anti cancer drugs) Use of drugs like quaternary ammonium compounds that cannot cross membranes. Treating conditions that require prolonged effects of a depot preparation Treating those who cannot or will not take oral meds |
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If a drug is highly protein bound, what are some implications?
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It is the unbound drug that is active
Need more drug (thus ↑ risk) Increased risk of drug-drug interactions |
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If drug (X), which is induced (increased metabolism) by P450, is given with drug (Y) that also induces P450, what will happen to the plasma level of drug X?
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It will decrease.
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If drug (X), which is inhibited by P450 (decreased metabolism) is given with drug (Y) an inducer (increases metabolism), what will happen to the plasma level of drug X?
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It will decrease
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If drug (X), which is induced (increased metabolism) by the P450, is given with drug (Y) that inhibits the P450 enzyme system, what will happen to the plasma level of drug X?
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It will increase
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If Drug (X) which is inhibited by the P450 enzyme system is given with drug (Y) that also inhibits the P450 enzyme system, what will happen to the plasma level of drug X?
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It will increase
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Briefly describe the pathophysiology of Parkinson’s Disease?
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Too little dopamine (inhibitory neurotransmitter)
Relative increase in Ach (excitatory neurotransmitter) Basal ganglia; involved with movement Rx aimed at restoring balance |
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What are the 2 major concepts of drug action regarding Parkinson’s Drugs?
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Drugs that replace or restore dopamine
Drugs that reduce ACh Meds are not a cure; they are only a treatment |
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Why can’t we just give the person dopamine?
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Dopamine cannot cross the BBB; metabolized by enzymes COMT and type B MAO too quickly
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What enzyme enhances the conversion of levodopa in dopamine?
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Decarboxylase
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What vitamin is needed to do this?
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Pyridoxine (B6)
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Do we want to encourage or discourage high vitamin B6 diets and/or vitamin B6 supplements?
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Discourage
High B6 would increase dopamine metabolism in the periphery, thus decrease the amount of dopamine able to cross the BBB (where it is needed) |
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What is meant by the terms:
“wearing off” “on-off phenomenon” |
Wearing off: effects of the drug (levodopa) have become sub-therapeutic; return of Parkinson symptoms too quickly
On-off: effects of drug suddenly wear off, symptoms abruptly return; hours to minutes, unsure of why |
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What is the advantage of Sinemet over levodopa alone?
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Carbidopa prevents peripheral metabolism of levodopa by blocking decarboxylase; thus more levodopa to cross BBB
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What are the major side effects of levodopa (Sinemet)?
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Postural hypotension
Dyskinesias (head bobbing, tics, grimacing) N and V Dysrhythmias Psychological disturbances in elderly |
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What class of drugs should be avoided in pts receiving levodopa?
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Cholinergics (> Ach)
MAOI (hypertensive crisis) Antipsychotic drugs (they block receptors for dopamine) Pyridoxine (B6) – (enhances the destruction of levodopa by decarboxylases) |
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What adjustments to the diet might need to be made for patients taking levodopa and why?
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Reduced protein
Protein competes with levodopa for entrance across the BBB (limited number of molecules accepted) Newer drugs: not as much as a problem |
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What effect will concurrent administration of cimetidine (Tagamet) have on phenytoin?
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Will decrease the rate at which phenytoin is metabolized, thus will increase phenytoin levels and can lead to potential toxic effects.
Valium, INH, ETOH, and valproic acid do the same |
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Name some drugs known to decrease phenytoin levels
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Carbamazepine
Phenobarbital |
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Drugs whose plasma levels can be reduced when phenytoin is given concurrently include…?
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1. oral contraceptives
2. warfarin 3. glucocorticoids |
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Describe how you would administer phenytoin (300 mg) IVP.
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Give no faster than 50 mg/min.
In the elderly: no faster than 25 mg/min (CV collapse) Mix only with saline (precipitates in D5W or Ringers Lactate) Assess ECG (do not give to pts with bradycardia or heart block) |
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A pt’s phenytoin level is reported at 14 mcg/mL. Is this WNL (within normal limits)?
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Normal limits: TL = 10-20 mcg/mL.
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Discuss the importance of monitoring plasma drug levels.
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Monitoring TL:
> chances of achieving effectiveness Evals adherence to therapy Aids in finding cause of loss of sx control ID cause of toxicity |
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When providing pt education re: anticonvulsant meds, what are the important points to cover?
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Take exactly as prescribed.
CNS SE < over time Avoid driving or using hazardous equip initially Do not stop drugs abruptly Avoid other CNS depressants Avoid OTC meds Food Effect < absorption Wear Med-Alert bracelet |
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Some anti-epileptics cause bone marrow suppression (eg. Aplastic anemia). What symptoms would you describe to the pt to be aware of and to report?
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Pallor
Weakness Easy bruising Petechiae Fever Sore throat |
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What water soluble vitamin absorption is often reduced with phenytoin and may require supplementation?
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Folic Acid
(Main excessive folic acid symptom: Itching!!!) |
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A pt who has a g-tube placed following a CVA is having seizures controlled with phenytoin. Can the adult phenytoin (Dilantin) capsule be opened, mixed with the tube feeding and be placed down the tube?
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NO
Mixing adult phenytoin with TF caused binding of phenytoin; thus < absorption Chewable Dilantin can be crushed & placed down a g-tube….BUT…. |
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Which AEDs should be avoided, if possible, during pregnancy?
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Valproic Acid
Carbamazepine |
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A pt calls the clinic asking if he can switch from Dilantin (brand name) to a generic phenytoin. What do you tell him?
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NO
D/T reduced availability (reason unknown) |
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A woman who has had no seizures while on valproic acid is now pregnant. What do you tell her about AED?
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She should take folic acid throughout her pregnancy while continuing to take valproic acid.
< risk of neural tube defects Have to consider the effects of a seizure on baby. |
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A woman who has had no seizures on phenytoin (or phenobarbitol) is now pregnant. What do you tell her about AEDs?
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> risk for bleeding
Should take 20 mg vitamin K QD during last few weeks of pregnancy Baby will be given 1 mg IM of vit K at birth |
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What are the advantages of fosphenytoin?
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Advantages:
IVP quickly Can be given with D5W or Ringers Lactate Very effective |
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What are the disadvantages of fosphenytoin?
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Disadvantages:
Phenytoin equivalent 150 mg fosphenytoin = 100 mg Dilantin Thus, an order for 100 mg phenytoin equivalent will cause pharmacy to send 150 mg of fosphenytoin which will equal 100 mg of phenytoin (accident waiting to happen) |
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How is Baclofen thought to work? (anti-spasticity)
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Mimics the action of GABA on spinal neurons
No direct effect on skeletal muscle |
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What patient education is necessary for those taking centrally acting muscle relaxants?
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CNS depression: drowsiness, dizziness, lightheadedness, fatigue
Avoid driving, operating hazardous equipment Avoid other CNS drugs (ETOH, opioids, antihistamines, benzos) |
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How does dantrolene work?
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Acts directly on skeletal muscle by suppression of calcium from sarcoplasmic reticulum, which < ability of skeletal muscle to contract.
Thus: a peripherally acting MR |
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For what anesthesia complication is dantrolene used to treat?
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Malignant hyperthermia
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Bethanechol (Urecholine) is a muscarinic __________ used primarily for treatment of __________.
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Agonist; Post-operative and post-partum urinary retention
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Identify the mechanism of action for Atropine (Sal-Tropine, Atropen), a muscarinic antagonist.
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Atropine prevents muscarinic receptor activation by ACH
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Muscarinic antagonist drugs should not be used with other drugs that produce muscarinic blockade. List some of these drug classes.
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Antihistamines; Phenothiazines; Antipsychotics; Tricyclic Antidepressants
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__________ is a muscarinic antagonist used in the treatment of overactive bladder.
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Oxybutynin
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Explain why a muscarinic antagonist is used to treat overactive bladder.
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Activation of muscarinic receptors on the bladder produces contraction of detrusor muscle and relaxation of the sphincter (both leading to bladder voiding); thus, a muscarinic antagonist will prevent these actions.
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Muscarinic antagonist poisoning is treated with __________.
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Physostigmine
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Identify the mechanism of action for cholinesterase inhibitors.
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Prevent acetylcholine degradation by acetylcholinesterase; thus, they intensify transmission at all cholinergic junctions.
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The nurse prepares to give oral Neostigmine to a patient with Myasthenia Gravis. What should the nurse do before administering this drug? Why?
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The nurse should assess the patient’s ability to swallow as Myasthenia Gravis is characterized by fluctuating muscle weakness.
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__________ is a depolarizing neuromuscular blocker used during short procedures such as endotracheal intubation, ECT, and endoscopy.
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Succinylcholine
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Adrenergic agonists can be divided into two groups: Catecholamines and Noncatecholamines. List several differences between these groups.
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Catecholamines: can’t use orally, can’t cross the BBB, brief duration of action; Noncatecholamines: longer ½ lives, can be given orally, able to cross the BBB
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The nurse is educating a patient who was just prescribed Prozasin (Minipress), an adrenergic antagonist, for hypertension. The nurse informs the patient of the first dose effect, which is __________.
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Severe postural hypotension occurring upon first dosing
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List several pharmacologic effects of Propanolol (Inderal, Innopran).
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Reduced heart rate, reduced force of ventricular contraction, reduced impulse conduction through the AV node
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Propanolol is contraindicated in which patient: a patient with a history of migraines, a patient presenting with angina pectoris, or a patient with diabetes.
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Propanolol is contraindicated in the patient with diabetes.
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A patient is preparing to discontinue use of Clonidine (a central acting Alpha 2 agonist). The nurse knows that abrupt withdrawal puts the patient at risk for __________. Knowing this, the nurse warns the patient to follow the doctor’s orders for discontinuation of this drug and to avoid abrupt withdrawal.
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Rebound Hypertension
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A patient has just been diagnosed with Parkinson’s disease. The nurse anticipates that the patient will be prescribed Levodopa along with __________, which enhances the effects of Levodopa.
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Carbidopa
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__________ is a drug used to treat Alzheimer’s Disease.
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Memantine
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__________ is a disease characterized by a chronic, inflammatory autoimmune response that damages myelin sheaths in the CNS.
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Multiple Sclerosis
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A patient taking an AED must withdraw the drug slowly because abrupt withdrawal can lead to ___________.
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Status Epilepticus
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What is the use of drugs to diagose, prevent, or treat disease or to prevent pregancy
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Therapuetics
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The most important properties of an ideal drug are...
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Effectiveness, Safety, Selectivity
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The most important property of an ideal drug is_______. If a drug is not ______ it should not be used
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Effectiveness
Effective |
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T or F? Some drugs are safe
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False
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T or F? Some drugs do not cause side effects
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False
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Who is the patients last line of defence against med errors
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Nurse
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T or F? The nurse should only administer drugs about which they know th action
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True
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What is the extent to which the patient's behavior coincides with medical advice
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Adherence/Compliance
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Before administration of a drug, what must the nurse do in order to evaluate the drug's effectiveness?
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Preadministration assessment
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What should the nurse evaluate in the evaluation phase of the nursing process?
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Therapeutic responses, adverse rxns, interactions, pt adherence, pt satisfaction
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An "off-label" use for a drug has not been evaluated by...
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FDA
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In which group of pts is our understanding of drug effectivness and safety limited?
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women, pregnant women, and children
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Each drug can have one _____ name but many _____ names.
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Generic
Trade |
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______ processes determine the concentration of a drug at its site of action and thereby determine the intensity and time course of responses
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Pharmacokinetics
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Drugs pass through membranes by one of three processes. Of the three, which one is most common
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Direct Penetration
The other 2 are passing through pores, and undergoing transports |
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______ found in the liver, kidney, placenta, intestine, and brain capillaries---can transport a variety of drugs out of cells
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P-glycoprotein
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______ soluble drugs can cross membranes easily, but________ drugs cannot
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Lipid
polar or ionized |
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Regarding a pH gradient bw two sides of a membrane, ______ drugs will accumulate on the alkaline side and ______ drugs will accumulate on the acidic side
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Acidic
Basic |
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Preparations of drugs are considered equal in ________ if the drug they contain is absorbed at the same rate and to the same extent
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bioavailibility
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The _______ refers to the tight junctions bw cells that compose capillary walls in the central nervous system
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Blood Brain Barrier
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T or F? The placenta constitutes an absolute barrier to the passage of drugs
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False
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T orF? While bound to albumin, drug molecules cannot leave the vascular system
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True
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Most drugs are excreted by the _______
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Kidney
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The _____________ is the plasma drug level below which therapeutic effects will not occur
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MEC
Minimum effective concentration |
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_____ is the biggest effect a drug can produce
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Maximal efficacy
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T or F? Potency and efficacy are interchangeable terms?
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False
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T or F? Upon binding to a receptor, a drug can produce cellular fxns not normally seen in a cell
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False
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____ make selective drug actions possible
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Receptors
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_____________ activate receptors, and __________ prevent receptor activation
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Agonist
Antagonist |
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The ____________ is the dose required to produce a defined therapeutic response in 50% of the population
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ED 50
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_________ interactions are beneficial when they increase therapeutic effects and detrimental when they increase adverse effects.
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Potentiative
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_________ interactions are beneficial when they decrease adverse effects and detrimental when decrease beneficial effects
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Inhibitory
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A drug that induces hepatic drug-metabolizing enzymes will have what effect of the metabolism of other drugs
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Accelerate
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Grapefruit juice can ________ blood levels of drugs
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Increase
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A medication label instructs you to administer a drug on an empty stomach. This drug must be given ___ hour before or ____ hours after a meal
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1
2 |
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An _______ disease is a drug or physician induced disease
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Iatrogenic
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T or F? An allergic rxn can occur with NO prior sensitization of the immune system
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False
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