A
Patients who have these conditions should be careful using NSAIDS:
diabetics (tough on kidney)
Cardiac pts (can cause fluid buildup)
asthma
nasal polyps
Which patient populations are at highest risk of death from narcotics?
1. elderly
2. pts w/ underlying resp issues
3. 24 hr post-op
If a patient reports _____, aspirin needs to be stopped immediately.
Tinnitus
What is the antidote for opioid overdoses?
naloxone (Narcan)
What medication should be avoided in children because it can cause Reye Syndrome?
Aspirin (ASA)
When treating a patient for gout with Allopurinol (Zyloprim), what are two things we need to make sure we routinely monitor?
1. CBC
2. eye exams
What is important to tell a patient taking a bilk forming laxative such as Psyllium (Metamucil)?
What are symptoms of opioid overdose?
1. pinpoint pupils (miosis)
2. Respiratory depression
3. unresponsive
What class of medications cannot be combined with blood thinners?
NSAIDS
Which narcotic causes an increased ICP and should not be used in patients with a brain injury?
morphine
What adverse effect of narcotic use that is not immediately life-threatening but still very important to monitor for?
Constipation
What is the antidote for acetaminophen?
A patient is ordered to receive low-dose aspirin (ASA) for arthritis. Which assessment, if found in the patient, is the highest priority for the nurse?
A. Otitis externa
B. Multiple bruises
C. Dry mouth
D. Aches in the joints
B. Multiple bruises
Rationale: Patients on aspirin therapy are at risk for bleeding such as ecchymosis (excessive bruising), dark tarry stools, bleeding gums, petechiae (round red spots), and purpura (large red spots).
A 65-year-old man has been diagnosed with chronic gout. The nurse anticipates that the patient will be treated with
A. allopurinol (Zyloprim).
B. colchicine.
C. adalimumab (Humira).
D. infliximab (Remicade).
A. allopurinol (Zyloprim).
Rationale: Allopurinol (Zyloprim) inhibits the final steps of uric acid biosynthesis and therefore lowers serum uric acid levels, preventing the precipitation of an attack. This drug is frequently used in the treatment of chronic gout as a prophylactic to prevent reoccurrences. Colchicine is effective in alleviating acute symptoms of gout. Infliximab (Remicade) and adalimumab (Humira) are immunomodulators used to treat moderate to severe rheumatoid arthritis by disrupting the inflammatory process and delaying the disease progression.
A 4-year-old child accidentally ingested multiple diphenoxylate-atropine tablets. The child is now very sleepy, respirations 8/min, pupils pinpoint, and skin is cool. What complication has occurred?
A. Opioid-induced respiratory depression
B. Atropine toxicity
C. Hypoglycemia
D. Febrile seizure
A. Opioid-induced respiratory depression
Diphenoxylate is an opioid → high doses cause respiratory arrest, especially in children.
Pinpoint pupils + slow breathing = classic opioid overdose.
A patient with gout is prescribed colchicine. It is most important for the nurse to give which instruction to the patient?
A.Increase vitamin C intake.
B.Avoid alcohol and caffeine.
C.Increase foods high in purines.
D.Take colchicine 2 hours before meals.
B.Avoid alcohol and caffeine.
Rationale: Alcohol and caffeine are to be avoided because they may increase uric acid levels. Vitamin C should not be taken in large doses because it may promote kidney stone formation. Purine foods increase uric acid levels and should be avoided. Antigout medications, especially colchicine, should be taken with food or at mealtime.
A patient receiving methotrexate for rheumatoid arthritis reports mouth ulcers, fever of 101.9°F, and petechiae on both legs. Labs:
WBC = 1,900
Platelets = 82,000
Hgb = 9.2
Which interpretation is MOST accurate?
A. Methotrexate toxicity causing bone marrow suppression
B. Expected immunosuppression
C. Iron-deficiency anemia
D. Viral illness unrelated to methotrexate
A. Methotrexate toxicity causing bone marrow suppression
Methotrexate can cause pancytopenia, which is deadly due to infection and bleeding risk.
Mouth sores + fever + low WBC/platelets = toxicity emergency.
What are some examples of Extrapyramidal Symptoms (EPS)?
1. muscle stiffness
2. tremors
3. eyes roll back
4. tardive dyskinesia
When should narcotics be held?
1. RR <12
2. O2 <90%
3. unarousable
4. fall asleep too easily
5. dizzy
EPS should be monitored for in patients taking these medications:
1. Dopamine Antagonists: Metoclopramid (Reglan)
2. Prochlorperazine (Compazine)
ANTIEMETICS!!
Ondansetron (Zofran) has a black box warning for which patient population and why?
Pregnant women because it can cause cleft palate in the fetus.
What are the potential side effects of each element of antacids:
aluminum
magnesium
calcium
sodium
aluminum = constipation
magnesium = diarrhea
calcium = kidney stones
sodium = HTN
A 75-year-old patient taking cimetidine for GERD suddenly becomes confused, agitated, and disoriented, with new-onset gynecomastia and elevated creatinine. What explains these symptoms?
A. Cimetidine toxicity causing CNS changes and hormonal effects
B. Expected aging-related confusion
C. Mild dehydration from diarrhea
D. Antacid overuse
A. Cimetidine toxicity causing CNS changes and hormonal effects
Cimetidine is known as the UGLY drug because it causes:
mental status changes (especially elderly),
gynecomastia,
kidney impairment,
major drug–drug interactions.
Its toxicity profile is significantly worse than famotidine or PPIs.
A patient taking oxycodone for severe back pain admits to drinking several beers with their dose. They now present with hypotension, extreme somnolence, and shallow breathing. What complication is most likely?
A. Potentiated CNS depression leading to respiratory failure
B. Simple alcohol intoxication
C. Oxycodone tolerance
D. Withdrawal from pain medication
A. Potentiated CNS depression leading to respiratory failure
Alcohol + opioids = synergistic respiratory depression, a leading cause of overdose death.
A chronic opioid user receives naloxone for suspected overdose. Minutes later, the patient develops vomiting, severe body aches, hypertension, tachycardia, and agitation. What is happening?
A. Precipitated opioid withdrawal
B. Allergic reaction
C. Panic attack
D. Hyperglycemia
A. Precipitated opioid withdrawal
Naloxone rapidly displaces opioids → violent withdrawal, which can cause arrhythmias or aspiration.