Gen Pharm
Which federal agency oversees safety and effectiveness of a medication vs. which federal agency oversees prescription and distribution of controlled substances?
FDA- Food and Drug Administration
DEA- Drug Enforcement Agency
What are some primary and secondary uses for diuretic therapy?
Primary- Fluid retention due to HF, CKD, or Liver Failure
Secondary- Hormone imbalances such as PCOS, treatment resistant acne
A patient taking insulin is found confused, diaphoretic, and shaky. What should the nurse assess first?
Blood sugar level
Tell me the mnemonic for Hypo/Hyperglycemia
Cold and Clammy.. Give em candy
High and Dry.. Sugar High
What is the Nursing Process?
Assessment
Planning
Diagnosis
Implementation
Evaluation
Why is knowing the half life of a medication important in administration of medications?
The half life of the medication indicates how frequently a medication must be taken in order to maintain therapeutic levels in the body.
Imbalances in which electrolyte are closely watched when prescribing Diuretics?
Potassium
Potassium wasting diuretics = Hypokalemia
Potassium sparing diuretics = Hyperkalemia
What kind of insulin is used to cover the Basal Insulin?
Long acting Insulin
Glipizide should NOT be administered to a patient with what type of allergy?
Sulfa drugs
How much medication can you administer in an IM injection?
1mL-3mL
Give me a reason why a patient may be at a higher risk for drug toxicity.
Infants have immature Liver and Kidney function
Elderly patients have a decline in their Liver or Kidney function
Patients with Liver or Kidney dx/dysfunction are unable to metabolize or excrete drugs adequately
Hydrochlorothiazide increases the excretion of Sodium at the ________________
Distal Convoluted Tubule
A patient needs insulin coverage for a blood glucose of 275 mg/dL before lunch. Which insulin would the nurse expect to use?
Rapid or Short acting insulin
What is a common side effect of Glipizide therapy?
Hypoglycemia
The medication is glucose independent, which means it will stimulate the Beta cells of the Pancreas to release insulin regardless of the patient's blood sugar.
The patient should be educated to eat within 30 minutes of taking the medication and make sure they have a steady intake of food throughout the day to avoid Hypoglycemia.
The patient should also be educated on the signs and symptoms of Hypoglycemia.
When giving an IM medication, what should the nurse do if blood appears in the syringe?
Withdraw the needle and dispose of it safely. Prepare a new injection.
Medications work in one of four ways in your body, name, explain, and give an example for 2 of them.
1. To replace missing chemicals.. Injected insulin replaces insulin deficiency in Type 1 DM
2. To increase or stimulate receptors .. Caffeine stimulates the CNS to increase alertness
3. To depress or inhibit receptors .. Beta Blockers inhibit Beta receptors in order to slow the HR and lower BP
4. To interfere with the functioning of a process .. Antibiotics kill or weaken bacteria
A patient is seen in the clinic for peripheral edema related to Heart Failure. The patient also has CKD. Which diuretic would be the most beneficial for this patient to be prescribed?
Loop Diuretic- Furosemide
A patient with Type 1 Diabetes is NPO for surgery.
Current orders:
Morning glucose: 132 mg/dL
Which action is most appropriate?
Hold Lispro, administer Glargine as ordered
What is the MOA of Metformin?
Reduces insulin resistance in the somatic cells
Decreases Hepatic glucose metabolism
How much medication may be given by Subq route?
0.5mL-1mL
Define Pharmacokinetics and tell me the four processes that make it up. Define each one briefly.
Pharmacokinetics- Movement of a drug through the body
Absorption- Movement of the drug from the site of administration to bloodstream
Distribution- Delivery of the drug from the bloodstream to the target tissue
Metabolism- Chemical break down or alteration of a drug by the body in order to use it
Excretion- How a drug is eliminated from the body
Gynecomastia would be an adverse reaction of which Diuretic? Explain why.
Spironolactone. Although it is an aldosterone antagonist, it also has anti-androgen effects that can decrease testosterone activity and increase the relative effects of estrogen, resulting in gynecomastia.
How do you mix insulins in a syringe?
Cloudy - Clear - Clear - Cloudy
1. Roll NPH (cloudy) in your hand gently and ensure your clear insulin is still clear
2. Draw up air in the syringe and inject in the cloudy vial first. Then inject air into the clear vial.
3. Draw up clear insulin into the syringe then draw up the cloudy insulin
Beta Blockers should be taken with caution with oral hypoglycemics, why?
Beta Blockers can mask the signs of Hypoglycemia
Five minutes after receiving a dose of Penicillin, the patient develops hives and starts to have dyspnea. What is the LVN expecting as the medical dx of this, what intervention does the LVN expect?
- the patient is showing signs of an allergic reaction with impending Anaphylaxis
- the LVN should assess the patient's airway and anticipate an order for Epinephrine
- the LVN should include in the patient's profile that the patient has an allergy to penicillin
Define what Onset, Peak, and Duration are and how they relate to medications
Onset – The amount of time it takes for a medication to begin producing a therapeutic effect.
Peak – The time at which a medication reaches its highest concentration or greatest therapeutic effect.
Duration – The length of time a medication produces a therapeutic effect.
This is important because it helps healthcare providers determine when a medication will begin working, when its effects will be strongest, and how long those effects will last, allowing for safe administration and optimal therapeutic outcomes.
A patient on diuretic therapy reports to the ED with complaints of muscle weakness, fatigue, and leg cramps. EKG shows flat T waves. What would you expect CMP to show?
Hypokalemia
A patient with Type 2 DM is stable on Oral Hypoglycemic therapy. The patient develops an infection and is admitted into the hospital. The LVN observes that the patient has an increase in his urine output and shares that he feels very thirsty and hungry all the time. What order would the LVN anticipate for this patient?
The patient is experiencing Hyperglycemia due to an increase in his stress.
The LVN should anticipate an order for ACHS Blood sugar monitoring and administering a rapid acting insulin based on a sliding scale.
The nurse receives report on four patients.
Which patient should be assessed first?
A. A patient taking metformin who reports mild diarrhea.
B. A patient taking glipizide who is diaphoretic and confused.
C. A patient taking metformin with a blood glucose of 180 mg/dL.
D. A patient taking glipizide who reports weight gain.
B
A patient with Chronic Kidney Disease is prescribed a medication that is primarily excreted through the Kidneys. What outcome is likely for this patient?
Increased risk of toxicity due to decreased ability to excrete the medication
A patient reports to the ED with extreme pain following a hip fracture. The provider prescribes a strong narcotic with the following onset, peak, duration, and half life:
Onset- 30 min
Peak- Peak 2 hrs
Duration- 6hrs
Half life- 3 hrs
10 minutes after administration, the patient yells out saying that he would like something else because "this medication isn't doing anything"
What is the best response by the LVN? What intervention can the LVN implement for this patient?
Explain that the medication has not reached its onset yet and requires a bit more time to take effect.
The LVN can use non-pharm techniques to manage the patient's pain such as applying ice, providing distraction, using guided imagery and deep breathing, provide emotional support, etc
A 74-year-old patient with heart failure is admitted for worsening shortness of breath and bilateral lower extremity edema. The provider prescribes IV furosemide.
Four hours after administration, the nurse notes:
Which finding is most concerning to the nurse?
Potassium level of 2.8 mEq/L
A patient receiving insulin reports palpitations, tremors, hunger, and anxiety. What physiologic response is causing these symptoms?
Activation of the sympathetic nervous system in response to hypoglycemia
A patient presents to the ED with the following clinical manifestations:
Trouble breathing, rapid/deep breathing
Severe stomach pain, nausea, vomiting, diarrhea, and anorexia
Unusual muscle pain, cramping, and generalized weakness.
Extreme, unexplained fatigue, unusual sleepiness, dizziness, and confusion.
MedRec shows the patient takes Metformin for Type 2 DM. What does the nurse anticipate has happened?
Lactic Acidosis associated with Metformin use.
This is a rare but life threatening adverse effect of Metformin therapy.
Treatment: Immediately dc metformin, monitor ABCs, stabilize the patient, and correct acidosis.
A patient is taking 2 medications that are metabolized by the same liver enzyme. What education is essential for the patient to be provided by the LVN?
It is best to take the medications apart from one another as one medication will alter the metabolism of another, leading to increased side effects or toxicity for the patient.