Weeks 1-2
This is the study of the metabolism and action of drugs with particular emphasis on the time required for absorption, duration of action, distribution in the body, and method of excretion? ______
This is the molecular interactions of a drug with specific biological receptors on or in the body's cells, which lead to a desired therapeutic response? ______
1. Pharmacokinetics
2. Pharmacodynamics
The nurse knows that which class of medications are intended for relieving acute symptoms and are most often administered via inhalation?
Short-acting beta2 agonists are intended for relieving acute symptoms and are most often administered via inhalation. By activating beta2 receptors in the lungs, the bronchi and bronchioles dilate, which relieves bronchospasm and allows more air to enter the lungs.
albuterol
levalbuterol
The student nurse knows that all the following are adverse effects of lisinopril except?
A. cough
B. hypokalemia
C. angioedema
D. renal failure
B. Hypokalemia
First-Dose Hypotension, cough, hyperkalemia, fetal injury, angioedema, renal failure
A postoperative patient who received an intravenous infusion of morphine has a respiratory rate of 8 breaths per minute and is lethargic. Which as-needed medication should the nurse administer to the patient?
A.Methadone [Dolophine]
B.Nalbuphine [Nubain]
C.Tramadol [Ultram]
D.Naloxone [Narcan]
•Answer: D
•Rationale: After surgery, naloxone may be used to reverse the excessive respiratory and central nervous system depression that can be caused by opioids.
The nurse knows that clavulanic acid is combined with certain penicillins to?
A. Increase activity against penicillinase producing bacteria
B. Increase activity against beta-lactamase producing bacteria
C. Increase stability in stomach acid
D. Increase duration of action of the antibiotic
B. Increase their activity against beta-lactamase producing bacteria
Which statement about drug agonists does the nurse identify as being true?
A. An agonist makes physiologic processes go faster.
B. An agonist exerts effects by causing receptor activation.
C. An agonist has moderate intrinsic activity.
D. An agonist is a dynamic component.
Answer: B
Rationale: It is important to note that agonists do not necessarily make physiologic processes go faster; receptor activation by these compounds can also make a process go slower. Receptors are dynamic components of the cell. A partial agonist is an agonist that has moderate intrinsic activity.
Your patient is taking inhaled fluticasone for their asthma control. The nurse should educate the patient that all the following are adverse effects of inhaled glucocorticoids except?
A. Oropharyngeal candidiasis
B. Adrenal suppression
C. low growth in children and adolescents
D. peptic ulcer disease
D. peptic ulcer disease is an adverse effect of oral glucocorticoids
Adverse effects of inhaled forms
Adrenal suppression, Oropharyngeal candidiasis, Dysphonia, Glucocorticoids can slow growth in children and adolescents; however, these drugs do not decrease adult height, Promotion of bone loss, Increased risk of cataracts, Increased risk of glaucoma
·Prolonged therapy with oral glucocorticoids can cause serious adverse effects, including adrenal suppression, osteoporosis, hyperglycemia, peptic ulcer disease, and growth suppression..
The nurse is taking care of a patient that is currently taking warfarin. The patient reports increased bruising and increased bleeding from their gums when brushing their teeth. The nurse would expect the provider to order what lab to monitor the warfarin therapy?
A. aPTT
B. serum warfarin
C. serum vitamin K
D. PT
D. Warfarin therapy is monitored by measuring PT. Results are expressed as an INR. An INR of 2-3 is the target for most patients.
The nurse knows that ibuprofen is generally a well tolerated medication and the incidences of adverse effects are low in most patients. Compared to aspirin, the nurse knows that ibuprofen increases a patients risk of ___ and ____ and thus should be used in the lowest effective dosage for the shortest possible time.
·although they can suppress platelet aggregation, these drugs are not used to prevent MI and stroke.
·These drugs actually increase the risk of MI and stroke and thus should be used in the lowest effective dosage for the shortest possible time.
The nurse knows that IV infusions of vancomycin should be given slowly to avoid the development of what syndrome?
Red Man Syndrome
•Give IV infusions slowly, over at least 60 minutes or longer
•Rapid infusion can cause flushing, rash, pruritus, urticaria, tachycardia, and hypotension (“Red Man” syndrome). Slow infusion reduces this risk.
Your patient has just been started on phenytoin. You educate your patient that abrupt discontinuation of phenytoin and other seizure medications can trigger?
convulsive status epilepticus.
The provider has just ordered a new medication for your patient. The nurse knows that what medication class should not be combined with SSRIs due to the risk of serotonin syndrome?
A. Non-steroidal anti-inflammatory drugs
B. Beta-blockers
C. Calcium Channel Blockers
D. Monoamine oxidase inhibitors
D. MAOIs
SSRIs can cause serotonin syndrome, especially when combined with MAOIs and other serotonergic drugs. Symptoms include agitation, confusion, hallucinations, hyperreflexia, tremor, and fever. Combined use of SSRIs and MAOIs is contraindicated.
The nurse is taking care of a diabetic patient who is receiving insulin therapy. The nurse knows that which of the following drug classes should be used in caution with this patient due to the risk of hypoglycemia.
A. glucocorticoids
B. beta-blockers
C. sympathomimetics
D. second generation antipsychotics
B. Beta blockers
In diabetics, it can mask signs and symptoms of hypoglycemia and prevent glycogenolysis. Beta-blockers can make insulin-induced hypoglycemia even worse by preventing the body's natural counterregulatory response.
All the other agents listed increase blood pressure.
The nurse knows that the two major adverse effects of the sulfonylureas are? (SATA)
A. Hypoglycemia
B. Weight Gain
C. Weight Loss
D. Lactic Acidosis
Major Adverse Effects (sx = symptoms)
Lactic acidosis metformin
Which statement about St. John’s wort does the nurse identify as true?
Answer: D
Rationale: Combining St. John’s wort with certain drugs can intensify serotonergic transmission to a degree sufficient to cause potentially fatal serotonin syndrome. Although St. John’s wort can enhance serotonergic transmission by itself, its effect is relatively weak; when used alone, the herb poses little risk. However, if St. John’s wort is combined with other serotonin-enhancing agents, the risk is greatly increased; therefore, St. John’s wort should not be combined with such drugs. Also, because St. John’s wort has a variety of known adverse interactions and is likely to have more that are as yet unknown, caution is clearly advised. St. John’s wort is not recommended for treating depression in patients taking other medications. St. John’s wort greatly reduces levels of digoxin, a drug for heart failure. For patients with mild to moderate major depression, St. John’s wort appears superior to placebo and equal to tricyclic antidepressants. For patients with severe depression, there is no convincing proof of efficacy.
The nurse knows that the principle adverse effects of levodopa includes all the following except?
A. nausea
B. dyskinesias
C. hypertension
D. psychosis
C. Hypertension
The principle adverse effects of levodopa are nausea, dyskinesias, hypotension, and psychosis
A patient is currently taking lithium for management of their bipolar disorder. The nurse reviews their serum drug levels and expects the value to fall within what range for the maintenance phase. ___ to ___ mEq/L
0.8 to 1.4 mEq/L for initial therapy and 0.4 to 1 mEq/L for maintenance. Levels should be measured every 2 to 3 days during initial therapy and only every 3 to 6 months during maintenance.
This medication should be avoided during pregnancy, especially in the first trimester due to the risk of birth defects.
The nurse caring for a patient with edema that requires diuresis. The patient has a positive history for kidney failure with low GFR. The nurse would expect the provider to order which of the following medications for this patients edema?
A. lisinopril
B. hydrochlorothiazide
C. spironolactone
D. furosemide
The nurse is taking care of a patient who just took their oral diabetic medication. The nurse knows the medication is a type of sulfonylureas and believes the patient may be experiencing hypoglycemia. The nurse recognizes which of the following as signs of hypoglycemia?
A. tremors
B. tachycardia
C. pinpoint pupils
D. sweating
Correct: A, B, D
The major adverse effect of sulfonylureas is hypoglycemia
Hypoglycemia: tremors, tachycardia, palpitations, sweating, nervousness, headache, confusion, drowsiness, fatigue
Pinpoint pupils related to opioid overdose. Dilated pupils can be a sign of hypoglycemia.
The nurse is providing education to a new nurse about tetracycline. Which statement made by the new nurse would indicate for the need for additional teaching?
A. I should tell my patients to take this medication with milk to prevent nausea and vomiting.
B. This medication can stain developing teeth
C. There is a contraindication for use with pregnant women and children younger than 8 years of age
D. Diarrhea may indicate a potentially life-threatening suprainfection of the bowel
A. Tetracycline should not be taken with calcium as it can impair absorption
A nurse is providing education to a patient who has been started on multiple new medications. The nurse should advise the patient to avoid driving when taking which of the following medications?
A. topiramate
B. baclofen
C. levodopa
D. warfarin
B. baclofen
Centrally acting muscle relaxants can cause severe drowsiness initially. Patients should be advised not to drive or engage in activities that may be hazardous.
A patient is taking theophylline for management of asthma. The nurse reviews the patients labs and the serum theophylline levels are 15 mcg/mL. The nurse would assess for what signs of toxicity?
A. none, this is a normal level
B. nausea
C. diarrhea
D. restlessness
Levels between 5-15mcg/mL are beneficial for most patients, but may go up to 20 mcg/mL.
Plasma levels of 20 to 25 mcg/mL: Nausea, vomiting, diarrhea, insomnia, restlessness
Plasma levels above 30 mcg/mL: Severe dysrhythmias (eg, ventricular fibrillation) and convulsions
The optimal range for digoxin is ___ to ___ ng/mL
Signs of toxicity: dysrhythmias. Noncardiac: n/v, anorexia, fatigue, and visual disturbances (blurred or yellow vision) frequently foreshadow more serious toxicity (dysrhythmias) and should be reported immediately.
The nurse is educating a patient about insulin lispro. The nurse knows that it is important to know the onset, peak, and duration of this medication. Please provide the onset, peak, and duration for insulin lispro (Humalog).
Insulin lispro (Humalog)
A patient who is in the early stages of Wernicke-Korsakoff syndrome has been admitted to the healthcare facility. Upon assessment of the patient, the nurse expects to find all but which manifestation?
Answer: C
Rationale: Fixed, dilated pupils are associated with severe neurologic damage or opiate drug overdose. Wernicke-Korsakoff syndrome is a serious disorder of the central nervous system, caused by thiamin deficiency, that has neurologic and psychologic manifestations. Symptoms include nystagmus, diplopia, ataxia, and inability to remember the recent past. Failure to correct the deficiency may result in irreversible brain damage.