Name That Drug!
First-line options for many adults include thiazide/thiazide-like diuretics, ACE inhibitors, ARBs and CCBs; selection depends on comorbidities, pregnancy and patient characteristics.
ANTIHYPERTENSIVES
Phenytoin (Dilantin) can and is used to manage:
Focal and tonic-clonic seizure control; Limits high-frequency neuronal firing.
What drug or class may cause Hyperglycemia, increased infection risk, insomnia/mood changes, appetite/weight gain, fluid retention/HTN, GI irritation. Long-term: adrenal suppression, osteoporosis, muscle weakness, cataracts/glaucoma, Cushingoid changes?
Corticosteroids
If a patient is taking Warfarin (Coumadin) its a good idea to have ______ on hand in the instance of an overdose.
Vitamin K (phytonadione)
A patient receiving calcitonin for osteoporosis asks how the medication works. Which explanation is most accurate?
A. It stimulates the thyroid to produce more hormones.
B. It increases osteoclast activity to rebuild bone.
C. It inhibits osteoclast activity, reducing bone breakdown.
D. It increases calcium absorption from the intestines.
Correct Answer: C
Rationale: Calcitonin inhibits osteoclasts, the cells that break down bone. This slows bone resorption and can lower blood calcium levels.
This ACE inhibitor ends in “-pril,” treats hypertension, and may cause a persistent dry cough. Name the medication.
What is lisinopril?
Rationale: Lisinopril blocks ACE, reducing angiotensin II and promoting vasodilation. It also reduces bradykinin breakdown, which can contribute to a persistent dry cough.
A patient with hypertension is prescribed furosemide (Lasix). This medication blocks sodium, potassium, and chloride reabsorption in the Loop of Henle. What is its primary purpose?
What is to increase urine output and reduce excess fluid volume?
Rationale: Furosemide is a loop diuretic that increases sodium and water excretion. It is commonly used for edema and fluid overload, including in patients with heart failure. Nurses monitor potassium, magnesium, sodium, renal function, and fluid status.
A patient taking propranolol develops a heart rate of 44 beats/minute and dizziness. Which adverse effect should the nurse suspect?
What is bradycardia?
Rationale: Propranolol is a nonselective beta blocker that decreases heart rate and cardiac contractility. The nurse should assess the patient, hold the dose according to prescribed parameters, and notify the prescriber.
A patient taking the statin Atorvastatin (Lipitor)reports severe muscle pain and weakness with dark, cola-colored urine. What serious complication should the nurse suspect?
What is rhabdomyolysis?
Rationale: Statins can rarely cause severe muscle breakdown, known as rhabdomyolysis. Damaged muscle cells release myoglobin into the bloodstream, which can damage the kidneys and lead to acute kidney injury (AKI). The nurse should report these symptoms promptly and anticipate orders for creatine kinase (CK), renal function tests, and urinalysis.
Why do we monitor renal function when administering levetiracetam (Keppra)?
A. The kidneys filter and eliminate most of the medication through urine.
B. The liver metabolizes the medication, increasing the risk of liver failure.
C. The medication causes potassium retention and fluid overload.
D. The kidneys activate the medication before it enters the bloodstream.
A. The kidneys filter and eliminate most of the medication through urine.
Rationale: Keppra is primarily excreted unchanged by the kidneys. Impaired renal function can cause the medication to accumulate in the body, increasing the risk of adverse effects. The dose may need to be adjusted based on renal function.
Inhibits osteoclasts (cells that break down bone), so bone loss slows and density can improve.
Alendronate
What is ticlopidine (formerly Ticlid) for?
This antiplatelet medication was historically used to reduce the risk of thrombotic stroke by inhibiting ADP-mediated platelet activation and aggregation. Name the medication.
A patient receiving alteplase for an eligible acute ischemic stroke suddenly develops a severe headache and new neurological changes. What is the nurse’s priority?
What is to suspect intracranial hemorrhage and initiate an immediate emergency response?
Rationale: Alteplase increases the risk of serious bleeding, including intracranial hemorrhage. Sudden severe headache or new neurological changes require immediate assessment and emergency intervention according to protocol.
A patient taking clopidogrel reports unusual bruising and bleeding gums. What is the nurse’s priority actions?
________ and _________.
Assess the patient for bleeding and notify the prescriber.
Rationale: Clopidogrel inhibits platelet aggregation, increasing the risk of bleeding. Unusual bruising and bleeding gums may indicate an adverse effect. The nurse should assess for additional signs of bleeding and report the findings promptly.
A nurse is caring for a patient receiving warfarin. Which laboratory result should the nurse monitor to evaluate the medication’s anticoagulant effect?
A. Serum potassium
B. International normalized ratio (INR)
C. White blood cell count
D. Blood glucose
B. International normalized ratio (INR)
Rationale: Warfarin therapy is monitored using PT/INR. According to your study material, the typical therapeutic INR range is 2.0–3.0. The dose is adjusted based on coagulation study results.
This antiseizure medication is associated with gingival overgrowth, has a narrow therapeutic range, and requires monitoring for toxicity. Name the medication.
What is phenytoin (Dilantin)?
Rationale: Phenytoin helps control seizures but can cause gingival overgrowth, ataxia, nystagmus, and serious skin reactions. Drug levels and clinical signs help identify toxicity.
A nurse is reviewing a patient's medication list. Which medication is an antifungal used to treat certain fungal infections?
A. Ketoconazole
B. Levetiracetam
C. Atorvastatin
D. Clopidogrel
A. Ketoconazole
Rationale: Ketoconazole is an antifungal medication that interferes with fungal cell membrane synthesis. It can cause serious liver toxicity and significant drug interactions. Oral ketoconazole has restricted uses because of these risks.
A patient taking pregabalin reports muscle pain, tenderness, and weakness accompanied by fever and malaise. Which serious adverse effect should the nurse suspect?
Rhabdomyolysis
Rationale: Pregabalin has been associated with rare cases of rhabdomyolysis, a condition involving muscle breakdown. The nurse should monitor for muscle pain, tenderness, and weakness accompanied by malaise or fever. According to the provided material, the medication should be discontinued if rhabdomyolysis is suspected, and the prescriber should be notified promptly.
A nurse is assessing four patients receiving different medications. Which patient requires the most immediate nursing intervention?
A. A patient taking aspirin who reports ringing in the ears.
B. A patient taking pregabalin who reports mild dizziness.
C. A patient taking alendronate who reports mild stomach discomfort after taking the medication.
D. A patient taking atorvastatin who asks whether the medication should be taken every day.
A. A patient taking aspirin who reports ringing in the ears.
Rationale: Tinnitus can indicate salicylate toxicity in a patient taking aspirin. The nurse should assess the patient promptly and notify the prescriber as appropriate. The other findings may require assessment or teaching, but tinnitus is a potential warning sign of aspirin toxicity.
A nurse is caring for a postoperative patient who received IV morphine 20 minutes ago. The patient is difficult to arouse, has a respiratory rate of 7 breaths/min, and an oxygen saturation of 86%. Which action should the nurse take first?
A. Administer the next prescribed dose of analgesic to prevent breakthrough pain.
B. Stimulate the patient, support oxygenation and ventilation, and initiate emergency assistance.
C. Document the findings as an expected adverse effect of opioid analgesics.
D. Reassess the patient’s pain level in 30 minutes.
B. Stimulate the patient, support oxygenation and ventilation, and initiate emergency assistance.
Rationale: The patient exhibits signs of potentially life-threatening opioid-induced respiratory depression. Airway and breathing take priority. The nurse should provide immediate respiratory support and emergency assistance; naloxone may be indicated according to protocol and the patient’s condition.
This thrombolytic activates plasminogen to form plasmin, which breaks down fibrin and dissolves blood clots. Name the medication.
What is alteplase (tPA)?
Rationale: Alteplase is used for specific emergencies, including eligible acute ischemic stroke. Its major risk is severe bleeding, including intracranial hemorrhage.
A patient with nonvalvular atrial fibrillation is prescribed rivaroxaban (Xarelto). What is the primary action of this medication?
A. Inhibits vitamin K–dependent clotting factor production in the liver.
B. Selectively inhibits factor Xa to prevent blood clot formation.
C. Breaks down existing blood clots by activating plasminogen.
D. Prevents platelets from sticking together by blocking ADP receptors.
Correct Answer: B. Selectively inhibits factor Xa to prevent blood clot formation.
Rationale: Rivaroxaban is an oral anticoagulant and direct factor Xa inhibitor. It is used to prevent stroke and systemic embolism in patients with nonvalvular atrial fibrillation and to prevent or treat DVT and PE. By inhibiting factor Xa, it reduces thrombin generation and clot formation.
A nurse is teaching a patient who takes ASA (aspirin) daily for antiplatelet therapy. Which symptom should the patient report immediately because it may indicate a serious adverse effect?
A. Mild thirst after taking the medication
B. Ringing in the ears (tinnitus)
C. Increased appetite
D. Occasional sneezing
B. Ringing in the ears (tinnitus)
Rationale: Tinnitus can be a sign of salicylate toxicity, particularly with higher aspirin doses. The nurse should assess for other warning signs, such as confusion, sweating, diarrhea, and hyperventilation, and report concerning symptoms promptly.
A nurse is teaching a patient prescribed alendronate for osteoporosis. The patient states, "I will take the medication with my morning coffee and lie down afterward." Does this statement need correction? If so, why?
Yes,
Rationale: Alendronate can irritate and damage the esophagus when taken incorrectly. It should be taken with plain water, and the patient should remain upright according to the medication’s administration instructions. Coffee and lying down afterward increase the risk of complications.
A nurse receives reports on four patients. Which patient should the nurse assess first?
A. A patient who received IV morphine for postoperative pain and is difficult to arouse, with a respiratory rate of 7 breaths/min and oxygen saturation of 86%.
B. A patient taking clopidogrel who reports new bruising and bleeding gums but is alert and has stable vital signs.
C. A patient taking pregabalin who reports muscle soreness and weakness but has no fever or other symptoms.
D. A patient taking warfarin whose INR is 2.5 and who has no signs of bleeding.
A. The patient receiving IV morphine who has severe respiratory depression.
Rationale: The patient has signs of potentially life-threatening opioid-induced respiratory depression. Airway and breathing take priority. The nurse should immediately stimulate the patient, support oxygenation and ventilation, activate emergency assistance, and prepare to administer naloxone according to protocol and clinical orders.
Option B: New bruising and bleeding gums require prompt assessment because clopidogrel increases bleeding risk.
Option C: Muscle pain and weakness in a patient taking pregabalin warrant assessment, particularly if severe or accompanied by fever or malaise.
Option D: An INR of 2.5 is within the typical therapeutic range of 2.0–3.0 provided in your warfarin notes, assuming the patient's prescribed target is that range.