1
Q
What is the Patient Education about life threatening adverse effects of hormonal contraceptives?
A
- High doses of estrogen can cause venous thromboembolism (VPE), myocardial infarction (MI), stroke.
- Non life-threatening side effects include dysmenorrhea, menorrhagia, chloasma, cyclic breast changes.
- St. Johns wort can reduce effectiveness
- Chasteberry extract can make it less effective
2
Q
What are the contraindications to hormone replacement therapy?
A
1) Pregnancy
2) History of endomentrial cancer
3) Personal history of breast cancer
4) History of thromboembolic disorders
5) Acute or chronic liver disease
6) Active gallbladder or pancreatic disease
7) Coronary artery disease
8) Undiagnosed vaginal bleeding
9) Endometerosis
10) Lifestyle such as smoking
11) History of fibroid tumors - until a year after last menstruation
3
Q
What is the opportunistic infections in HIV patients?
A
- Pulmonary TB, pneumococcal pneumonia, cryptosporidium, fungal infections, raposi sarcoma, toxoplasmosis, histoplasmosis, and cytomegalovirus
4
Q
What is the Patient Education for patients with HIV?
A
- Educate PT about adherence to the the therapeutic program
- Explain common emotional responses
- For PT of childbearing age, explain how HIV transmission to the the unborn baby can occur
- Teach safe sex and how not to spread HIV
- Inform PT about OTC meds and herbal sups interactions with antiretrovirals
- Assist with a system for taking the correct dose of the correct drug at the correct time
- Counsel PT about the importance of having adequate supply of drugs to avoid interruption in the dosing schedule
5
Q
What is the assessment you do for patients receiving Amphotericin B?
A
- Obtain a medical history that included any serious renal or hepatic disorders
- Assess the ability to swallow
- Assess any prior use of antifungals
- Check lab tests for liver function, ALP, ACT, AST, GGT, BUN, bilirubin, serum creatinine
6
Q
What is the treatment for Candida infection? ***
A
Nystatin (Mycostatin)
- Can be swished and swallowed or swished and spit*
7
Q
What is the patient education about isoniazid? ***
A
- Take 1NH??? 1 hour ac or 2 hours pc
- Must finish the medication
- Collect sputum specimen in early morning
- Take pyridoxine (Vitamin B) to prevent peripheral neuropathy
- Check liver enzymes
- Need frequent eye exams
- Report numbness, tingling, burning
- Teach sun precautions, avoid antacids
- Decreases phenytoin effect when concurrent
8
Q
What is the patient education about rifampin?
A
- Warn PT that body fluids may be reddish orange
9
Q
What is the Patient teaching that is significant about fluconazole?
A
- Contraindicated with chronic alcoholism (Hepatoxic)
- May affect glycemic control in diabetic patients; monitor blood sugar
- Advise that hypoglycemia may occur with concurrent oral sulfonylureas
- Monitor BUN, creatinine, serum liver enzymes, electrolytes
- DO NOT drink alcohol
- Finish regimen completely - can result in relapse if not alone
10
Q
What are the nursing intervention for extravasation of intravenous doxorubicin?
A
Stop the IV infusion of doxoruidicin
11
Q
What is the Z-track method of medication administration?
A
- Recommended for IM injections to minimize local skin irritation by sealing the medication in the muscle tissue
- Z track - hold skin taut, inject needle into deep muscle tissue, aspirate for blood, if no blood slowly inject med, keep needle in for 10 seconds then let it go
12
Q
What are the side effects of Nifedipine?
A
1) Headache
2) Hypotension
3) Dizziness
4) Flushing of the skin
5) Peripheral edema
- The immediate release form of nifedipine has been associated with an increased incidence of sudden cardiac death *
13
Q
What is the patient instructions for antibiotic therapy?
A
- Finish the entire course
- May decrease the effectiveness of oral contraceptives
14
Q
What is the Patient teaching for bisacodyl (Dulcolax) therapy?
A
- May cause reddish brown urine, do not take h.s.
- Do not use if pregnant (can cause spontaneous abortion)
- Too much use can cause electrolyte imbalance
- Causes mild cramping and diarrhea
15
Q
What is the purpose of proton pump inhibitor (PPI) medication?
A
- Suppress gastric acid secretion by inhibiting the hydrogen (H)/ Potassium (K+) ATpase enzyme system located in the gastric parietal cells
16
Q
What are the side effects of cimetidine (Tagamet) in elderly patients?
A
- H2 histamine antagonist, anti-ulcer med
- Geriatric PTs appears on BEERS lists
- Geriatric PTs are more susceptible to adverse CNS reactions
- low dose recommneded
- BEERS list is medications contraindicated in older adults *
17
Q
What are antacid administration and other medications?
A
- Antacids diminish absorption of H2 receptor blockers
- Antacids neutralize hydrochloric acid and reduce pepcin activity *
- Administer 2h before or after other drugs !!
- Magnesium based products may cause diarrhea
- Aluminum based may cause constipation or aggravate kidney stones
- Assess PT for signs of renal insufficency
18
Q
What are peak levels? ***
A
- Is the highest plasma concentration of drug at a specific time and indicated rate of absorption
- Are requested for drugs that have a narrow therapeutic index and are considered toxic *
19
Q
What are trough levels? ***
A
- Lowest plasma concentration of a drug and it measures the rate at which the drug is eliminated
- Are requested for drugs that have a narrow therapeutic index and are considered toxic *
20
Q
What are the contraindications of tetracycline?
A
- 1st broad spectrum antibiotic
- DO NOT give to children younger than 8 years or pregnant women it causes discoloration of permanent teeth
- Renal and hepatic dysfunction
- Can cause teratogenic effects in pregnant women
21
Q
What is the Patient education for tetracycline therapy?
A
- Instruct PT to store away from heat and light (becomes toxic by breakdown)
- Advise PT to check expiration dates (out of date can be toxic)
- Inform females considering pregnancy to avoid because it can cause teratogenic effects
-Warn that children 8 or younger should not take because it permanently causes discoloration of permanent teeth - Encourage PT to take complete course as prescribed
22
Q
What are alternative therapy if patient has hypersensitivity to penicillin?
A
- Erythromycin is commonly prescribed to PT with hypersensitivity to penicillin
(Macrolides, lincosamides, glycopeptides, and ketolides)
23
Q
What medication should not be given with lansoprazole?
A
- Rilpivirine - and antiretroviral agent used to treat HIV is contraindicated with all PPI (proton pump inhibitor)
- Lansoprazole is a proton pump inhibitor that suppresses gastric acid secretion by inhibiting the enzyme hydrogen or ATPase which makes gastric acid
24
Q
What are the reasons for palliative therapy in cancer patients?
A
To relieve disease related symptoms and improve quality of life
25
What is the nursing action if patient receiving penicillin is having hypersensitivity reactions?
- Mild reaction involves treatment with an anti-histamine and a major reaction involves epinephrine, bronchodilators, and antihistamines
** ALSO discontinue the medication**
- The patient who is hypersensitive to amoxicillin should not take any type of penicillin products because severe allergic reaction could occur. A small percentage of patients who are allergic to penicillin could also be allergic to a cephalosporin product.
- Have epinephrine available to counteract a severe allergic reaction
- Can be alleviated some by taking penicillin with food.
26
What are the adverse effects of bismuth subsalicylate (Pepto-Bismol) ?
- This medication is a adsorbent - absorbs bacterial toxins
1) Dizziness
2) Drowsiness
3) Weakness
4) Headache
5) Tongue and Stool discoloration
6) Anxiety
7) Confusion
8) Tinnitus
9) Abdominal pain
10) Hearing loss
27
What is the difference between Diphenoxylate with Atropine (Lomotil) and Loperamide (Imodium)? ***
- Diphenoxylate with atropine is an opiate prescribed as an antidirrheal. Used to treat traveles diarrhea and chronic diarrhea. It is 50% atropine to discourage drug abuse.
** Contraindicated in PTs with glaucoma**
- Loperamide reduces fecal volume, decrease intestinal fluid and electrolyte loss
- Diphenoxylate decreases abdominal cramping, intestinal cramping, and hypersecretion
- Loperamide is structurally related to diphenoxylate but causes less CNS depression than diphenoxylate and difenoxin. Loperamide can also be purchased as an OTC.
- Children and older adults who take diphenoxylate are more susceptible to respiratory depression than are other age groups
28
What is the action of Anticholinergics as an antidiarrheal ?
- Diphenoxylate with atropine is an opium with anticholinergic properties (atropine) that decreases GI motility (peristalsis)
- Many side effects are caused by the anticholinergic atropine.
- PTs with severe glaucoma should take another antidiarrheal that does not have an anticholinergic effect. If this drug is taken with alcohol, narcotics, or sedative-hypnotics, CNS depression can occur
29
What does mineral oil hinder from absorbing? ***
-Reduces the absorption of fat-soluble vitamins such as vitamin K and vitamin A,
Lubricants such as mineral oil increase water retention in the stool
- Mineral oil is not indicated for children, older adults, or PTs with debilitating disease because they might aspirate the mineral oil, resulting in lipid pneumonia
30
What is the Patient lifestyle practice that affects the absorption of cimetidine (Tagamet)?
**Absorption of this H2 blocker may be impaired in smokers**
- Advise PT to avoid smoking because it can hamper the effectiveness of the drug
- Remind PTs that the drug must be taken exactly as prescribed to be effective
- Warn PTs to not drive a motor vehicle or engage in dangerous activities until stabilized on the drug
- Alert PTs to avoid foods and liquids that cause gastric irritation, such as caffeine-containing beverages, alcohol, and spices
31
What are the drugs that may interact with H2 antagonist?
By inhibiting hepatic drug metabolism, it enhances the effects of oral anticoagulants, theophylline, caffeine, phenytoin, diazepam, propranolol, phenobarbital, and calcium channel blockers
- Should also not be taken with iron because its H2-blocking action could be decreased
32
Who must use antacids containing magnesium with caution?
- Pregnant women should use magnesium containing antacids with caution because they can cause fetal renal, respiratory, cardiovascular, and muscle problems.
- They are contraindicated in PTs with impaired renal function because of the risk for hypermagnesemia.
33
What are the adverse effects of Aluminum-containing Antacid?
1) Hypophosphatemia
2) Hypercalcemia
3) Hypomagnesemia
4) Osteoporosis
5) Nephrolithiasis
6) GI Obstruction
- In PTs with renal insufficiency it can cause encephalopathy from accumulation of aluminum in the brain
34
What are the adverse effects of Topical Acyclovir?
- It can cause local irritations such as Urticaria, and contact lenses should be removed before instilling ophthalmic antivirals.
- It also includes nausea, vomiting and diarrhea, headache, dizziness, rash and pruritus, and hematuria
** Herpes antiviral - anemia, paresthesias, crystalluria, neuropathy, seizures, nephrotoxicity, blood dycrasias
35
What is the nursing diagnosis for Aminoglycoside therapy?
-They are inhibiting bacterial protein synthesis.
- Risk for injury (Renal damage)
- Tissue injury
- Nausea
- Vomiting
- Nephrotoxicity is an adverse reaction to most aminoglycosides
-Obtain a medical hx related to renal or hearing disorders. Large doses of aminoglycosides could cause nephrotoxicity or ototoxicity
- Monitor peak & through levels and for superinfection
- PT needs to wear sunscreen
36
What is Selegiline (Eldepryl action in Parkinson’s disease?
- It inhibits MAO-B thus prolonging the action of levodopa
- Used in combination with levodopa or
levodopa, carbidopa.
- It works to increase and extend the effects of levodopa, and may help to slow the progress of Parkinson's disease.
- May cause dizziness, headache, orthostatic hypotension, nausea (most reported), constipation, depression, confusion, insomnia, and ataxia.
- Contraindicated with any other MAOI, SSRI, or SNRI; titrate off drug, never abruptly d/c; avoid foods high in tyramine, such as aged cheese, red wine, and bananas
-
37
What do you monitor with a child with ADHD (attention deficit hyperactivity disorder)?
- Monitor PTs with cardiac disease because Methylphenidate may cause tachycardia, hypertension, and stroke.
- Monitor vital signs and report irregularities
- Monitor PTs for side effects such as insomnia, restlessness, nervousness, tremors, irritability, tachycardia, and elevated blood pressure. Report findings
- Monitor weight, sleep patterns, and mental status
38
What is the treatment for overdose of benzodiazepines?
You treat it with Flumazenil
- May cause drowsiness, dizziness, blurred vision, ataxia, seizures, hyperacusis, palpitations, vomiting, and dry mouth
39
What are the serious reaction to trimethoprim-sulfamethoxazole (Bactrim)?
1) Agranulocytosis
2) Aplastic anemia
3) Myocarditis
** All are possible life-threatening conditions **
40
What are the adverse effects of Aminoglycosides antibiotic treatment?
- Serious adverse reactions to aminoglycosides include ototoxicity and nephrotoxicity. (ear & kidney)
- Prolonged use of aminoglycosides could result in a superinfection, and specific serum aminoglycoside levels should be closely monitored to avoid adverse reactions
41
What are the adverse side effects of Ciprofloxacin (Cipro), a fluoroquinolone?
* A urinary antibacterial*
1) Neurotoxicity
2) Crystalluria
3) Myasthemia
4) Ileus
5) GI Bleeding
6) Hypercholesterolemia
7) Tendon rupture
8) Bradycardia
Life-threatening:
1)Anaphylaxis
2) Angioedema
3) Anemia
4) Leukopenia
5) Agranulocytosis
6) Thrombocytopenia
42
What is the Patient teaching about Bisacodyl (Dulcolax)?
- It may cause mild cramping and diarrhea
- Encourage PTs to increase water intake
- Advise PTs to avoid overuse of laxatives, which can lead to fluid and electrolyte imbalances and drug dependences. Suggest exercise to help increase peristalsis
- Dont chew the tablets but swallow whole
- Educate PTs not to take the drug within 1 hour of any other drug
- Encourage PTs to time administration of the drug so as not to interfere with activities or sleep
43
What are the adverse effects of Ondansetron (Zofran)?
* Suppresses nausea and vomiting by blocking serotonin (secretion antagonist)*
1) Headache
2) Dizziness
3) Hypotension
4) Palpitations
5) Constipation
6) Edema
7) Fatigue/malaise
8) Constipation
9) Diarrhea
44
What are the predispositions to Peptic ulcer disease?
- It includes mechanical disturbances, genetic influences, bacterial organisms, environmental factors, and certain drugs
-Mechanical disturbances: Hyper secretion of acid and pepsin; inadequate GMB mucous secretion; impaired GMB resistance; hypermotility of stomach; incompetent (defective) cardiac or pyloric sphincter.
-Genetic influences: Inc. # of parietal cells in stomach; susceptibility of mucosal lining to acid penetration; susceptibility to excess acetylcholine and histamine; excess hydrochloride acid caused by external stimuli.
- Environmental: Foods and liquids containing caffeine; fatty, fried, and highly spiced foods; alcohol; nicotine, especially from cigarette smoking; stressful situations; pregnancy; massive trauma; major surgery.
- H. Pylori- gram- negative bacterium, H. pylori, infects gastric mucosa & can cause gastritis, gastric ulcer and duodenal ulcer. If no eradicated, peptic ulcer may return as frequently as every year; can also lead to atrophic gastritis. Serology & special breath tests.
-Drugs: NSAIDs including aspirin and aspirin compounds, ibuprofen, and indomethacin; corticosteroids; potassium salts; antineoplastic drugs
45
What is the treatment for Hypothyroidism?
Levothyroxine
46
Clinical Judgement Management Model (CJMM) ****
It was designed to measure a nursing licensure candidate's ability to exercise sound clinical judgment and decision making.
47
What is dawn phenomenon?
- Hyperglycemia on awakening is known as the dawn phenomenon
- The PT usually awakens with a headache and reports night sweats and nightmares.
- Management of the dawn phenomenon involves increasing the bedtime dose of insulin
48
Treatment for Diabetes Insipidus
Desmopressin acetate
** Rare condition in which the kidneys are not able to conserve water**
49
What is the first-pass effect?
- When drugs are metabolized in the liver to an inactive form and are excreted, thus reducing the amount of active drug available to exert a pharmacological effect.
-It is the metabolism of a drug BEFORE it reaches the systemic circulation
50
What are the adverse effects of Sulfonylurea (Glipizide)?
1) Hypoglycemia
2) Hyponatremia
3) Dyspnea
4) Angioedema
5) Porphyria
6) GI Bleeding
51
What is the Somogyi effect?
- A response to an excessive dose of insulin, diabetic PTs may develop what is known as the Somogyi effect, a hypoglycemic condition.
- It usually occurs in the predawn hours of 2:00 am to 4:00 am wherein a rapid decrease in blood glucose during the nighttime hours stimulates a release of hormones
- Management of the Somogyi effect involves monitoring blood glucose between 2:00am and 4:00am and reducing the bedtime insulin dosage
52
What is the interaction between Penicillin and Warfarin?
Warfarin levels may be increased and may lead to bleeding (Increased anticoagulant effect)
53
What is the treatment for diarrhea due to antibiotic therapy?
Encourage probiotics like yogurt to assist normal flora
54
What are the safe laxatives for long term use?
- Bulk-forming laxatives (fiber supplements):
* Safe Laxatives are:
1)Polycarbophil
2)Polyethylene glycol
3)Methylcellulose
4)Psyllium
**PTS with hypercalcemia should avoid calcium polycarbophil because of the significant amount of calcium in the drug**
- Proton pump inhibitor- PPI
(Associated with osteoprosis in long term use)
- Monitor live function and serum gastrin for long term
55
What are the normal Dilantin (phenytoin) levels?
- Therapeutic range - 10 to 20 mcg/mL
- Free/unbound range - 1 to 2 mcg/mL
* Seizure control medication (Antiseizure) *
56
What is the oral hypoglycemic agent that decreases hepatic production of glucose?
- Second generation sulfonylureas
Ex. Glimepiride and Glipizide
57
What are the group of drugs that antibiotic therapy interacts with?
* Drugs that interact with Combined Hormonal Contraceptives (CHC):
1) Amoxicillin
2) Ampicillin
3) Doxycycline
4) Metronidazole
5) Minocycline
6) Neomycin
7) Nitrofurantoin
8) Tetracycline
** Drug inteactions that can occur with the use of urinary antiseptics/antiinfectives:
1) Antacids decrease Nitrofurantoin
2) Sodium bicarbonate inhibits the action of Methenamine
3) Methenamine taken with sulfonamides increases the risk of crystalluria
4) Most urinary antiseptics cause false-positive Clinitest (glucose urine test) results
58
Beta blockers and Type 2 Diabetes?
- In insulin-dependent diabetics, beta-blockers can prolong, enhance, or alter the symptoms of hypoglycemia, while hyperglycemia appears to be the major risk in non insulin-dependent diabetics. beta-blockers can potentially increase blood glucose concentrations and antagonize the action of oral hypoglycemic drugs
- Beta blockers block the release of insulin by interacting with nerve signals to the pancreas and thus lower its levels. This can cause hyperglycemia, or high blood sugar.
