Chapter 13:Immunosuppressant drugs
What is the relation of taking oral Methotrexate to food?
Take on an empty stomach
Which of the following statements is incorrect?
I should wear gloves when handling the body fluids of a patient on chemo
My patient on chemo should not have fresh fruit
My patient on chemo can receive flowers, it will lift their mood
My patient on chemo should be watched for thrombocytopenia
My patient on chemo can receive flowers, it will lift their mood
Which of the following is an administration guideline for Iron supplementation?
Take with OJ
Do not take with grapefruit juice
Chew well to increase absorption
Do not take with food
Take with OJ
Which medication cannot be combine with Omeprazole?
Clonazepam
Clopidogrel
Ciprofloxacin
Cefazolin
Clopidogrel
Which N/V medication is used for vertigo?
chlorpromazine
odansetron
meclizine
demhydrinate
meclizine(Antivert)
For pediatric seizure medication dosing is based on _______.
Weight
Benzodiazepines/ Hydantoins
lorazepam, diapepam, clonazepam, phenytoin, fosphenytoin
All seizure medications can cause _____ which means a main nursing priority is ______. (ch 53 chart)
Sedation
Patient safety
One or the other
Therapeutic INR:
Normal INR:
Therapeutic INR: 2.0 to 3.0
Normal INR: 1.1 or below
Which medication can cause gingival hypertrophy
Methotrexate
Cyclosporin
Cellcept
Etanercept
Cyclosporin/tacrolimus
Which provider is able to give Chemotherapy?
An ICU nurse who has been a nurse for 10 years
Any nurse
A phlebotimist
A trained oncology nurse who has been a nurse for 1 year
A trained oncology nurse who has been a nurse for 1 year
Your patient is being prescribed Epoietin? How will the dosing be decided?
Sliding scale based on CBC
Always 25 mg
lowest possible effective dose
weight based
Use lowest possible dose to achieve desired effect
Which medications have the 1-2 hour rule? Select all that apply:
Calcium carbonate
Maalox
Omeprazole
Sucralfate
Ranitidine
Calcium carbonate, Maalox, Sucralfate
Calcium carbonate (TUMS), Mylanta, Maalox, Gaviscon, Alternagel, Amphogel- meals
Sucralfate- meds
Which N/V medication should not be administed IV?
meclizine
promethazine
odansetron
scopolamine
promethazine
Phenothiazines
promethazine (Phenergan)
prochlorperazine (Compazine)
chlorpromazine (Thorazine)
Which medication is used for Trigem Neuralgia
levetiracetam
carbamazepine
gabapentin
phenytoin
carbamazepine
Side effect of antispasmodics select all that apply:
Sedation
Nausea
Anticholinergic
Constipation
Seizure
Anticholinergic
The word seizure is derived from which language?
Latin
Greek
French
Spanish
derived from the Greek meaning “to take hold.
Which of the following are adverse effects of Methotrexate? Select all that apply
Diarrhea
Nausea
Vomiting
Anorexia
constipation
Diarrhea
Nausea/ vomiting
Your patient, who is on her third round of chemo, has complaints of mouth pain that has lead to difficulty talking and eating. Upon inspection you notice redness as well as a few white lesions on her inner cheek. What condition do you suspect?
gingival hypertrophy
thrush
stomatitis
periapical abscess
stomatitis
Select all that apply Iron supplementation adverse effects:
Nausea
Headache
Black stool
Constipation
Red emesis
Diarrhea
Flatulence
Stool may blacken
May cause: GI discomfort, nausea, constipation, diarrhea
When should Ranitidine be given?
Bedtime
BID breakfast and bedtime
Which medication is used for motion sickness?
meclizine
promethazine
odansetron
scopolamine
scopolamine
Your patient has not been taking his antiepileptic drugs. What life threatening condition is he at an increased risk of?
Status epilepticus
Prolonged seizure activity (30+ minutes)
Life threatening, Generalized tonic-clonic
Which antispasmodic is the most sedating
metaxalone (Skelaxin)
carisoprodol (Soma)
cyclobenzaprine (Flexeril)
lioresal (Baclofen)
cyclobenzaprine (Flexeril) ** this drug is the most sedating
ECT is used to treat depression, bioplar, and other psychiatric conditions. What lead to the start of ect?
Seizures showed improvement in psychiatric illness
It causes a seizure that induces positive outcomes
Who should not take Methotrexate?
A patient with a kidney transplant
A pregnant woman
A patient with lupus
A patient with hypertension
A pregnant woman: Pregnancy category X
Your patient is a 32 year old woman who just finished her last round of chemo last week. She tells you that she wants nothing more than to have a child after such a hard battle. What should you tell her?
You should wait at least a year before trying
You should wait at least a month before trying to conceive, chemo it teratogenic
You should wait several months before trying
You will not be able to have children, the risk of birth defects is too high
You should wait several months before trying
Chemotherapy is teratogenic, category X
Avoid pregnancy during treatment and for several months after treatment
espec 1st trimester, 2nd & 3rd may be safer, depends on drug
When taking Epoietin what increases the right of thrombus?
Hgb 12g/dL
Hct 9g/dL
WBC 300 g/dL
Hgb 8g/dL
Hgb 12g/dL
Your patient has H. Pylori. What is going to be the course of treatment?
Triple therapy * 2 antibiotics + 1 acid reducer* 14 day treatment
Can also add….
bismuth subsalicylate (Pepto; Kaopectate) not w/ ASA allergy
Which medications have anticholinergic effects? Select all that apply:
meclizine
promethazine
odansetron
scopolamine
meclizine
promethazine
scopolamine
Your patient is experiencing status epilipticus and you are giving lorazepam. How are you going to give it?
IM in the vastus lateralus
Slow IV push - 2mg/minute
Slow IV push- 20 mg/ minute
Sublingual 2mg
Slow IV push - 2mg/minute
What should be avoided while taking cyclobenzaprine?
alcohol or CNS depressants
bismuth subsalicylate should not be taken with an allergy to what?
ASA allergy
When on Cyclosporin/tacrolimus which of the following are things to watch for? Select all that apply:
Hypertension
Hypotension
Nephrotoxicity
Liver damage
Hyperkalemia
Hypokalemia
No grapefruit
Take with OJ
HTN, Nephrotoxicity, liver damage, hyperkalemia, No grapefruit
Which of the following needs to be monitored during Chemo? Select all that apply
BUN
Creatinine
GFR
AST/ ALT
Bilirubin (LFTs)
CBC
BUN, Creatinine, GFR, Urine output, I & O, weight, edema, AST, ALT, Bilirubin (LFTs), CBC
What are the major adverse (think life threatening) effects of Epoietin? (two correct answers)
Thrombus/ htn: MI/ stroke
Adverse effects: nausea, vomiting, diarrhea, arthralgias
Your patient comes to you with complaints of indigestion that will not go away. He states " I take an aspirin every morning for joint pain and I take a handful of tums for my indigestion. It helps for a little bit, but the pain always comes back in an hour or so". What may be causing his indigestion? Why aren't the TUMS working?
PUD/ GERD
Aspirin makes it worse
TUMS- rebound acidity
Anticholinergic- hospice to prevent pulmonary edema
Which of the following medications require serum drug levels? Select all that apply:
phenobarbital
lorazepam
phenytoin
fosphenytoin
carbamazepine
gabapentin
phenobarbital
phenytoin
fosphenytoin
carbamazepine
Monitor serum drug levels: barbituates, hydantoins, iminostibines
What time of day should Sucralfate be taken
30-60 minutes before each meal & bedtime
Do not admin within 2 hours before/after other meds
Which is abnormal:
Hct: 43
HBG: 13.8
Plt: 250
WBC: 3.0
WBC: 3.0
should be 3.8-10.4
Hct: 40-50
Hbg:13.6-16.9
Plt:152-324