question

alendronate sodium (brand name and classification)

answer

Binosto , Fosamax Therapeutic classification- bone resorption inhibitors Pharmacological classification- bisphosphonates

question

alendronate sodium method of action

answer

inhibits resorption of bone by inhibiting osteoclast activity.

question

alendronate sodium indication of use

answer

reverses the progression of osteoporosis with decrease in fractures decreases the progression of Paget's disease

question

alendronate sodium nursing considerations

answer

May cause musculoskeletal pain. Administer in the morning with 6-8 oz. glass of water 30 minutes before other medications, beverages or foods. Assess patient for low bone mass before and during therapy. Assess for symptoms of Paget's disease ( bone pain, HA, decrease in vision and auditory acuity and increase in skull size). Lab work- serum calcium for osteoporosis and alkaline phosphate for Paget's disease. Teach- have patient sit upright for 30 minutes following dose, take as directed and eat a healthy diet. Take calcium and vitamin D supplements as needed and use sunscreen. Notify HCP if pain or difficulty swallowing occurs.

question

metformin (brand name and classification)

answer

Glucophage Therapeutic classification- antidiabetic Pharmacological- biguanides

question

metformin method of action

answer

Decreases hepatic glucose production. Decreases intestinal glucose absorption. Increases insulin sensitivity.

question

metformin indication of use

answer

Management of type 2 diabetes

question

metformin side effects and adverse effects

answer

Adverse effects- lactic acidosis

question

metformin nursing considerations

answer

Administer with meals to decrease GI irritation. When combined with an oral sulfonylureas observe for signs and symptoms of hypoglycemic reaction. Labs- glucose levels, check folic acid and vitamin B12 levels every 1-2 years because this drug may interfere with absorption. Teach- Take at same time each day, instruct patient on how to properly test glucose levels, review the signs and symptoms of hyperglycemia and hypoglycemia with the patient.

question

docusate sodium (brand name and classification)

answer

Colace Therapeutic classification- laxative Pharmacological classification- stool softener

question

docusate sodium method of action

answer

Promotes the incorporation of water in stool resulting in softer fecal mass.

question

docusate sodium indication of use

answer

Prevention of constipation in patients who should avoid straining.

question

docusate sodium nursing considerations

answer

This medication does not stimulate peristalsis. Administer with a full glass of water. Assess for abdominal distention, bowel sounds and usual pattern of bowel function. Assess color, consistency and amount. Teach- should only be used for short term as it can cause a patient to become dependent. Encourage bulk in diet, increased fluid intake and mobility. Do not take within 2 hours of other laxatives.

question

Diphenhydramine (brand names and classifications)

answer

Benadryl Therapeutic classification- Allergy and cold, antihistamines, antitussives.

question

Diphenhydramine method of action

answer

Antagonizes the effect of histamine at H1 receptor sites, does not bind or inactivate histamine. Significant CNS depressive and anticholinergic properties.

question

Diphenhydramine indications

answer

Relief of allergic symptoms caused by histamine release: anaphylaxis, seasonal or allergic rhinitis, allergic dermatosis. Parkinson's disease and dystonic reactions from medications. Mild night time sedation. Prevents motion sickness. Antitussive.

question

Diphenhydramine Side effects and adverse effects

answer

Drowsiness, dry mouth, chest tightness

question

Diphenhydramine nursing considerations

answer

Administer with meals to reduce GI irritation. Determine why the medication is needed. Assess for delirium, confusion and fall risk Assess for patent airway Take as directed For dry mouth use oral rinses.

question

Plasminogen activators- alteplase, reteplase, streptokinase, tenecteplase (brand names and classification)

answer

alteplase- Activase reteplase- Retavase streptokinase- Streptase tenecteplase- TNKase Therapeutic classification- thrombolytic Pharmacological- plasminogen activators

question

Plasminogen activators method of action

answer

Directly converts plasminogen to plasmin, then degrades clot- bound fibrin. Lysis of thrombi in coronary artery, pulmonary emboli and stroke causing.

question

Plasminogen activators indication of use

answer

Acute MI, stroke, PE, occluded C venous access devices, DVT, peripheral artery thrombosis.

question

Plasminogen activator Side effects and adverse effects

answer

AE- intracranial hemorrhage, GI bleed, recurrent ischemia thromboembolism, GU tract bleed, anaphylaxis.

question

Plasminogen activator nursing considerations

answer

Over and under dose could result in death or harm. Use 2 IV lines- one for thrombolytic agent and additional infusions. Avoid invasive procedures. MI- Monitor VS every 4 hours especially BP, RR, HR If BP is higher than 180/110 notify HCP immediately. PE- measure hemodynamics and respiratory status. Stroke- assess neurological status, determine onset of stroke and this must be administered 3-4 hours of onset. Labs- Hgb, Hct, platelet, obtain type and cross match, test stools for occult blood. *high alert**- BLEEDING Teach- explain the purpose of medication, need for bedrest and minimal handling of patient to prevent bruises and injuries.

question

Thiamine hydrochloride brand names and classifications

answer

Vitamin B1 Therapeutic classification- vitamins Pharmacological- water soluble

question

Thiamine hydrochloride method of action

answer

required for carbohydrate metabolism.

question

Thiamine hydrochloride indication of use

answer

Thiamine deficiencies, Prevention of Wernicke encephalopathy, dietary supplement in patients with GI disease, alcoholism, cirrhosis.

question

Thiamine hydrochloride Side effect and adverse effect-

answer

This is extremely rare, usually associated with IV administration or large doses.

question

Thiamine hydrochloride nursing considerations-

answer

Assess for signs and symptoms of thiamine deficiency. Assess nutritional status. monitor for anaphylaxis. Labs- may interfere with theophylline, uric acid and urobillinogen concentrations.

question

disulfiram (brand name and classifications)

answer

Antabuse Therapeutic classification- alcohol abuse therapy adjuncts Pharmacological classification- enzyme inhibitor

question

disulfiram method of action

answer

inhibits the enzyme aldehyde dehydrogenase, resulting in toxic accumulation of acetaldehyde which is one of the initial breakdown products of alcohol. Discourages alcohol ingestion.

question

disulfiram indication of use

answer

management of chronic alcoholism in patients who require or desire an enforced state of sobriety.

question

disulfiram nursing considerations

answer

Administer once daily at bedtime to reduce daytime drowsiness. Assess for recent alcohol use. Do not administer for 12 hours following alcohol ingestion. If there is a severe reaction- administer oxygen, monitor ECG and potassium, provide supportive measures. Labs- LFT baselines after 10-14 days of therapy, CBC and blood chemistry every 6 months. Teach- may cause drowsiness.

question

chlorpromazine brand names and classifications

answer

Thorazine Therapeutic classifications- antiemetic's, antipsychotics Pharmacological- phenothiazine's

question

chlorpromazine method of action

answer

Alters the effect of dopamine in the CNS. Has significant anticholinergic/ alpha adrenergic blocking activity.

question

chlorpromazine indication of use

answer

Second line treatment for schizophrenia and psychosis after failure with atypical antipsychotics. Hyper excitable, combative behavior in children. Nausea and vomiting. intractable hiccups pre-op sedation vascular headache bipolar

question

chlorpromazine side effects and adverse effects

answer

SE- blurred vision, dry eyes, hypotension, constipation, dry mouth, photosensitivity AE- neuroleptic malignant syndrome, agranulocytosis.

question

chlorpromazine nursing considerations

answer

Administer oral dose with food, milk or full glass of water. IM- inject slowly in deep well developed muscle. Assess mental status, weight, BMI, positive and negative symptoms of schizophrenia, orthostatic blood pressure, pulse, fluid intake and bowel function. Monitor for akathisia- restlessness, tardive dyskinesia- uncontrolled rhythmic movement. Monitor for development of neuroleptic malignant syndrome ( fever, respiratory distress, tachycardia, convulsions, diaphoresis, HTN, hypotension, pallor, tiredness, severe muscle stiffness, loss of bladder control.) LABS- CBC, LFT, decreased HCT, HGB, leukocytes, granulocyte. Increase in bilirubin, ast, alt and alkaline phosphates. blood glucose levels, cholesterol and increased prolactin levels. TEACH- do not skip dose, take as directed change position slowly, may cause drowsiness, avoid alcohol or other CNS depressants, use sunscreen, frequent mouth rinses, may turn urine pink to reddish to brown color, notify HCP promptly if sore throat, fever, unusual bleeding or bruising, rash, weakness, tremors, visual disturbances, clay colored stool.

question

Filgrastim brand name and classification

answer

Neupogen, G-CSF Therapeutic- colony stimulating factors

question

filgrastim method of action

answer

Glycoprotein binds to and stimulates immature neutrophils to divide and differentiate, activates mature neutrophils.

question

filgrastim indication of use

answer

Prevention of febrile neutropenia and associated infection in patients who have received bone-marrow depressing antineoplastics for treatment of non myeloid malignancies. Reduction of time for neutrophil recovery and duration of fever in patients undergoing induction and consolidation chemo for acute myelogenous leukemia. Management of severe chronic neutropenia.

question

filgratism side effects and adverse effects

answer

SE- medullary bone pain AE- splenic rupture, acute respiratory distress syndrome, allergic reactions.

question

filgratism nursing considerations

answer

Administer after 24 hours of cytotoxic chemo, at least 24 hours after bone marrow infusion and not before or during chemo. Refrigerate- do not freeze, do not shake, may warm to room temperature up to 6 hours before injection. Monitor HR, RR, BP Assess for bone pain, allergic reactions, s/s of acute respiratory distress syndrome. Labs- CBC with differential- presents of blast cells- platelet count, may cause a decrease in platelet count, increase in uric acid, LDH and alkaline phosphatase concentrations. Teach- explain purpose of meds and notify HCP if pregnant or breast feeding.

question

epoetin alfa brand name and classification

answer

Epogen Therapeutic classification- anti-anemics pharmacological- hormones, ESA (erythropoietin stimulating agent)

question

epoetin alfa method of action

answer

Stimulates the production of RBC'S

question

epoetin alfa indication for use

answer

Anemia associated with CKD. Anemia secondary to AZT therapy in HIV patients. Anemia in patients receiving chemo for nonmyeloid malignancies. Reduction of the need for RBC transfusion in patients undergoing elective, non cardiac, non vascular surgery.

question

epoetin alpha side effects and adverse effects

answer

SE- HTN AE- seizures, HF, MI, stroke, thromboembolic events.

question

epoetin alpha nursing considerations

answer

Monitor BP- inform HCP if severe HTN is present or if BP begins to increase Monitor for symptoms of anemia Labs- increase in WBC and platelets, decrease in bleeding times. HGB AND HCT TEACH- patient to read med guide prior to therapy, explain rationale for concurrent iron therapy, notify HCP if s/s of clot.

question

simvastatin brand name and classification

answer

Zocor Therapeutic- lipid lowering agent pharmacological- hmgCoA reductase inhibitor

question

simvastatin method of action

answer

Inhibits HMG-COA reductase which is an enzyme responsible for catalyzing an early step in synthesis of cholesterol.

question

simvastatin indication for use

answer

increases HDL cholesterol and decreases LDL cholesterol.

question

simvastatin side effects and adverse effects

answer

SE- cramps, diarrhea, flatus, heart burn, constipation AE- rhabdomyolysis

question

simvastatin nursing considerations

answer

Obtain diet hx- fat consumption Notify HCP of muscle pain.

question

esomeprazole brand name and classification

answer

Nexium Therapeutic- Anti-ulcer Pharmacological- PPI

question

esomeprazole method of action

answer

Binds to an enzyme on gastric parietal cells in presence of acidic gastric pH, preventing final transport of hydrogen ions into gastric lumen.

question

esomeprazole indication for use

answer

PO and IV- Gerd PO- zollinger-ellison syndrome PO with amoxicillin and clarithromyacin to eradicate H. pylori in duodenal ulcer PO- decrease risk of gastric ulcer during continuous NSAID therapy.

question

esomeprazole side effects and adverse effects

answer

AE- pseudomembranous colitis

question

esomeprazole nursing considerations

answer

May be used with antacids. Take 1 hour before meals and swallow whole Assess for epigastric and abdominal pain, frank or occult blood in stool. Assess bowel function. Avoid NSAIDS, alcohol, foods that increase GI irritation.

question

rivaroxaban brand names and classification

answer

Xarelto Therapeutic- anticoagulants Pharmacological- antithrombotics

question

rivaroxaban method of action

answer

Acts as a selective factor x inhibitor that blocks the active site of factor xa, inactivating cascade of coagulation.

question

rivaroxaban indication of use

answer

Prevention of DVT that may lead to pulmonary embolism following knee or hip replacement surgery. Reduction in risk of stroke/ systemic embolism in patients with non valvular atrial fibrillation.

question

rivaroxaban side effects and adverse effects

answer

AE- bleeding

question

rivaroxaban nursing considerations

answer

When switching from warfarin to this- discontinue warfarin and start this as soon as INR < 3.0 to avoid periods of inadequate coagulation. Discontinue 24 hours prior to surgery. Assess for signs of bleeding and hemorrhage. Labs- increase in AST, ALT, total bilirubin and GGT levels. Teach- take as directed, report symptoms of unusual bleeding, no alcohol, OTC or herbal products, especially NSAID and aspirin.

question

protamine sulfate brand name and classification

answer

protamine sulfate Therapeutic- antidotes Pharmacological- antiheparins

question

protamine sulfate method of action

answer

Strong base that forms a complex with heparin ( an acid) inactivation of heparin

question

protamine sulfate indication for use

answer

Acute management of severe heparin overdose.

question

protamine sulfate side effects and adverse effects

answer

AE- HYPERSENSITIVITY REACTIONS- anaphylaxis, angioedema and pulmonary edema.

question

protamine sulfate nursing considerations

answer

Discontinue heparin infusions. Assess- bleeding, hemorrhage- which may occur 8-9 hours after therapy due to rebound effect of heparin. Allergy to fish (salmon), vasectomized and infertile men increase the chance of hyper reaction. Labs- clotting factors, ACT, aPTT, thrombin time (5-15 minutes after therapy). Teach- Purpose and avoid activities result in bleeding.

question

Vitamin K brand names and classification

answer

Mephyton, vit. K Therapeutic- antidotes Pharmacological- fat soluble vitamins

question

Vitamin K method of action

answer

Required for hepatic synthesis of blood coagulation factors II, VII, IX and X

question

Vitamin K indications for use

answer

Prevention of bleeding due to hypoprothombinemia. Excessive dose of oral anticoagulant. salicylates. Certain anti-infective agents Nutritional deficiencies. Prolonged total parenteral nutrition. Prevention of hemorrhagic disease in NB.

question

Vitamin K nursing considerations

answer

Fatal hypersensitivity reactions IV FOR VITAMIN k NOT RECOMMENDED. Monitor for frank and occult bleeding, monitor pulse and BP frequently. Labs- PT- to determine response Teach- Do not drastically alter diet, take as directed, avoid IM and drastic events leading to injury.

question

furosemide/bumetanide brand name and classification

answer

Lasix Therapeutic- diuretic pharmacological- loop diuretic

question

furosemide/bumetanide method of action

answer

Inhibits the reabsorption of sodium and chloride from loop of Henle and distal renal tubule

question

furosemide/bumetanide indication of use

answer

Edema due to HF, hepatic impairment or renal disease, HTN

question

furosemide/bumetanide side effects and adverse effects

answer

SE- dehydration, fluid and electrolyte imbalances AE- erythema multiforme, stevens Johnson syndrome, toxic epidermal necrolysis, aplastic anemia

question

furosemide/bumetanide nursing considerations

answer

May be taken with food. Assess - fluid status, daily weight, I&O, edema, lung sounds, skin turgor, mucus membranes Monitor- BP, pulse Assess for tinnitus and hearing loss, allergies to sulfa drugs. Labs- electrolytes, renal and hepatic function, glucose and uric acid levels before and throughout. May cause a decrease in K+, Na+, Ca and Mg. May increase BUN, glucose, creatinine and uric acids. Teach- take as directed, change positions slowly, diet high in K+, use sunscreen, monitor glucose carefully if a diabetic, notify HCP if weight gain more than 3 lbs. in a day, and if rash, muscle weakness, cramps and N/V are present.

question

spironolactone brand names and classifications

answer

Aldactone T- diuretic P- potassium sparing diuretic

question

spironolactone method of action

answer

Loss of sodium bicarbonate and calcium while saving K+ and hydrogen ions- antagonizing aldosterone.

question

spironolactone indication for use

answer

Management of edema- HF, cirrhosis and nephrotic syndrome. Manage HTN Treat hypokalemia

question

spironolactone SE and AE

answer

SE- hyperkalemia AE- drug rash with systemic symptoms, topic epidermal necrolysis.

question

spironolactone nursing considerations

answer

Administer PO in Am to avoid interrupting sleep pattern. Assess for development of hyperkalemia ( fatigue, muscle weakness, paresthesia, confusion, dyspnea, arrhythmias. Monitor I&O, BP, ECG'S If patient has skin rash discontinue- Steven's Johnson syndrome. Labs- K+, BUN, creatinine, electrolytes may cause increase in Mg, uric acid, BUN, creatinine, K+, plasma renin and Ca excretion levels. May cause a decrease in Na+ levels. Discontinue 3 days prior to glucose tolerance tests. Teach- avoid salt substitutes, may cause dizziness

question

hydrochlorothiazide brand names and classifications

answer

Microzide T- antihypertensive, diuretic P- thiazide diuretic

question

hydrochlorothiazide method of action

answer

Increases excretion of sodium and water by inhibiting sodium reabsorption in distal tubule. Promotes excretion of chloride, K+, hydrogen, Mg, phosphate, Ca and bicarbonate. May produce arteriolar dilation

question

hydrochlorothiazide indication of use

answer

Management of HTN Treatment of edema due to- HF, renal dysfunction, cirrhosis, estrogen therapy, glucocorticoid therapy.

question

hydrochlorothiazide SE and AE

answer

SE- hypokalemia AE- Steven's Johnson syndrome

question

hydrochlorothiazide nursing considerations

answer

Take medication in the Am to prevent disruption of sleep. Give with food to help with GI irritation. Monitor BP, I&O, weight Allergy to sulfa drugs.

question

methadone ( Dolophine, Methadose) T/P

answer

T-opioid analgesics P- opioid agonist

question

methadone ( Dolophine, Methadose) MOA

answer

Binds to opiate receptors in CNS. Alters the perception of and response to painful stimuli, while producing generalized CNS depression.

question

methadone ( Dolophine, Methadose) Indication of use

answer

Management of moderate to severe chronic pain in patients requiring use of continuous around the clock opioids. Detoxification and maintenance therapy for opioid disorder. Decreased severity of pain. Suppress withdrawal symptoms.

question

methadone ( Dolophine, Methadose) SE/AE

answer

SE- confusion, sedation, hypotension, constipation AE- torsades de pointes

question

methadone ( Dolophine, Methadose) nursing considerations

answer

May administer with food or milk. Assess pain- type, intensity and location Assess BP, Pulse, respirations- if RR is lower than 10 check level of sedation, bowel function. Opioid detoxification- assess for signs of opioid withdrawal ( runny nose and eyes, abdominal cramps, body aches, sweating, loss of appetite.) Labs- may increase amylase and lipase levels. Teach- may cause dizziness and drowsiness, change position slowly, encourage patient to turn, cough, and turn every 2 hours to prevent atelectasis.

question

pantoprazole ( Protonix) T/P

answer

T- Antiulcer agent P- PPI

question

pantoprazole ( Protonix) MOA

answer

Bind to an enzyme in the presence of acid gastric pH. Prevents the final transport of hydrogen ions into gastric lumen.

question

pantoprazole( Protonix) indication for use

answer

Erosive esophagitis associated with Gerd. Decreases the relapse of daytime and nighttime heartburn symptoms on pts with GERD. Adjunctive treatment of duodenal ulcers associated with H.pylori.

question

pantoprazole ( Protonix) SE/AE

answer

AE- pseudomembranous colitis

question

pantoprazole (Protonix) nursing considerations

answer

Monitor bowel functions. may be administered with or without food Labs- abnormal LFT including increase in AST, ALT, alkaline phosphatase and bilirubin. Teach- take as directed for full course therapy. avoid alcohol, products containing aspirin or NSAID and foods that may cause an increase GI irritation. report onset of black tarry stools diarrhea or abdominal pain.

question

vancomycin hydrochloride (Vancocin) T/P

answer

T- anti-infective

question

vancomycin hydrochloride (Vancocin) MOA

answer

Binds to bacterial cell wall resulting in cell death.

question

vancomycin hydrochloride (Vancocin) indication

answer

IV- potentially life threatening infections when less toxic anti-infectives are contraindicated for example: endocarditis, meningitis, osteomyelitis, pneumonia, septicemia PO- due to clostridium difficile.

question

vancomycin hydrochloride (Vancocin) SE/AE

answer

SE- nephrotoxicity, phlebitis AE- anaphylaxis

question

vancomycin hydrochloride (Vancocin) nursing considerations

answer

Assess patient for infection. Obtain specimen for culture and sensitivity. Monitor IV site closely. Monitor BP. I&O- if it is cloudy or pink it may be a sign of nephrotoxicity Watch for signs of superinfection Teach- report signs of vertigo, tinnitus, and hearing loss

question

enoxaparin ( Lovenox) T/P

answer

T- anticoagulant P- antithrombotics, low molecular weight heparin.

question

enoxaparin ( Lovenox) MOA

answer

Potentiates the inhibitory effect of antithrombin on factor XA and thrombin.

question

enoxaparin (Lovenox) indications

answer

Prevents of venous thromboembolism, DVT, and PE in med surg patients. Treatment of DVT with or without PE. Prevention of ischemic complications from unstable angina and non-ST-segment elevation MI.

question

enoxaparin (Lovenox) SE/AE

answer

Bleeding, anemia

question

enoxaparin (Lovenox) nursing considerations

answer

Alternate injection sites daily. Assess for bleeding and hemorrhage. Assess angina pain. Labs- monitor CBC, platelet and stools for occult blood. If Hct decreases unexpectedly assess for possible hemorrhage. Increase in AST, ALT levels Hyperkalemia For overdose use Protamine sulfate Teach- Do not take aspirin, ibuprofen and naproxen

question

hydromorphone (Dilaudid) T/P

answer

T- allergy, cold and cough remedies, opioid analgesic P- opioid agonist

question

hydromorphone (Dilaudid) MOA

answer

Binds to opiate receptors in the CNS. Alters perception of and response to painful stimuli

question

hydromorphone (Dilaudid) indications of use

answer

Moderate to severe pain. Antitussive- low dose

question

hydromorphone (Dilaudid) SE/AE

answer

confusion, sedation, hypotension, constipation.

question

hydromorpone (Dilaudid) nursing considerations

answer

May be administered with food or milk. Assess BP, pulse and respirations. Bowel function and pain Lab- increase plasma amylase and lipase Antidote for overdose is naloxone. Teach- avoid concurrent use of alcohol or other CNS depressants. Change position slowly. Notify HCP if pain control is not adequate or side effects occur. May cause dizziness and drowsiness.

question

clopidogrel bisulfate (Plavix) T/P

answer

T- anti-platelet agents P- platelet aggregation inhibitor

question

clopidogrel bisulfate (Plavix) MOA

answer

Inhibits platelet aggregation by irreversibly inhibiting the binding of ATP to platelet receptors.

question

clopidogrel bisulfate (Plavix) indications for use

answer

Reduction of atherosclerotic events in patients at risk for such events including MI, acute, coronary syndrome, stroke, peripheral vascular disease.

question

clopidogrel bisulfate (Plavix) SE/AE

answer

AE- GI bleeding, drug rash with eosinophilia and systemic symptoms, bleeding, neutropenia, thrombotic thrombocytopenic purpura.

question

clopidogrel bisulfate (Plavix) nursing considerations

answer

Discontinue 5-7 days before planned surgical procedure. Take once daily without regard to food. Assess patients for symptoms of stroke, peripheral vascular disease or MI. Labs- Bleeding time, CBC with differential, platelet neutropenia, and thrombocytopenia- these rarely occur. Increase serum bilirubin, hepatic enzymes, total cholesterol, non protein nitrogen and uric acid concentrations. Teach- Take as directed, notify HCP of fever, chills, sore, throat, rash, unusual bleeding or bruising.

question

fentanyl citrate (Actiq) T/P

answer

T- opioid analgesic P- opioid agonist

question

fentanyl citrate (Actiq) MOA

answer

Binds to opiate receptors in CNS- altering response to and perception of pain.

question

fentanyl citrate (Actiq) indications for use

answer

Management of breakthrough cancer pain in patients with malignancies who are already receiving and are tolerant to opioid therapy for underlying cancer pain.

question

fentanyl citrate (Actiq) SE/AE

answer

SE-dizziness, drowsiness, nausea AE- respiratory depression.

question

fentanyl citrate (Actiq) nursing considerations

answer

Monitor type, location and intensity of pain. Assess BP, pulse and respiratory rate. Change position slowly. Antidote- naloxone.

question

warfarin (Coumadin) T/P

answer

T- Anticoagulant P- Coumarin

question

warfarin (Coumadin) MOA

answer

Interferes with hepatic synthesis of vitamin K- depending clotting factors.

question

warfarin (Coumadin) indications of use

answer

Prophylaxis and treatment of venous thrombosis, PE and atrial fibrillation with embolization. Management of MI. Prevention of thrombus formation and embolization after prosthetic valve placement.

question

warfarin (Coumadin) SE/AE

answer

Bleeding

question

warfarin (Coumadin) nursing considerations

answer

Use a soft toothbrush, floss gently and shave with an electric razor. Report any symptoms of unusual bleeding or bruising. Do not take antiplatelet medications or drink alcohol. Wear a medic alert bracelet. Assess client for signs of bleeding and hemorrhage. Monitor PT and INR AS WELL AS CBC. Assess stool and urine for occult blood before and throughout therapy. The medication requires 3-5 days to reach effective levels. Antidote- vitamin K. Teach- do not eat excessive amounts of food containing vitamin K.

question

levothyroxine (Synthroid) T/P

answer

T- Hormone P- thyroid hormone

question

levothyroxine (Synthroid) MOA

answer

Metabolism of all nutrients is increased, promoting cell growth and increased protein synthesis

question

levothyroxine (Synthroid) indication of use

answer

Replacement therapy in clients without thyroid hormone or pharmacologic doses to enhance diminished thyroid function.

question

levothyroxine (Synthroid) SE/AE

answer

Usually only seen when excessive doses are given causing hyperthyroidism.

question

levothyroxine (Synthroid) nursing considerations

answer

Administer in Am before breakfast with full glass of water on an empty stomach to prevent insomnia. The heart may beat faster increasing oxygen demands in myocardium. It may lead to angina or MI. Monitor T3, T4 and thyroid stimulating hormone- TSH is high when thyroid levels are low. Monitor glucose, weight and increasing physical and mental energy. Teach- report chest pain, palpitations or dizziness immediately. Report excessive weight loss.

question

metoclopramide (Reglan) T/P

answer

T-Antiemetic P- gastric- stimulant

question

metoclopramide (Reglan) MOA

answer

Blocks dopamine receptors in chemoreceptor trigger zone of the CNS. Stimulates motility of the upper GI tract and accelerates gastric emptying.

question

metoclopramide (Reglan) indication of use

answer

Prevention of emesis related to chemotherapy and surgery. Reduction of GERD. Prevention of microaspiration in clients with enteral feedings. UNLABELED- treatment of hiccups.

question

metoclopramide ( Reglan) SE/AE

answer

SE- drowsiness, extrapyramidal reactions ( dystonia, akathisia, tardive dyskinesia, parkinsonism) restlessness. AE- neuroleptic malignant syndrome-( muscle rigidity, fever, autonomic instability, cognitive changes such as delirium)

question

metoclopramide (Reglan) nursing considerations

answer

Assess for nausea, abdominal distention, and bowel sounds before administering. Observe for EPS (extrapyramidal symptoms). Observe for depression. Monitor hepatic panel and serum prolactin and aldosterone increase. Teach- may cause drowsiness, report any tremor or uncontrollable muscle contraction immediately. Maintain hydration and protect from extremes of temperature. Avoid CNS DEPRESSION.

question

budesonide- fluticasone- ( Pulmicort Respules) T/P

answer

T- Anti- inflammatory agent P- corticosteroid agent

question

budesonide (Pulmicort Respules) MOA

answer

Potent, locally acting anti-inflammatory and immune modifier.

question

budesonide ( Pulmicort Respules) indication of use

answer

Maintenance treatment of asthma as prophylactic therapy.

question

budesonide (Pulmicort Respules) nursing considerations

answer

Monitor respiratory status and lung sounds. Assess clients changing systemic to inhalation corticosteroids for signs of adrenal insufficiency. Periodic adrenal function tests may be ordered. May cause increased serum and urine glucose concentrations if significant absorption occurs. Teach- Use bronchodilator before using corticosteroid- allow 5 minutes to elapse between. This drug is not to be used for an acute asthma attck. Rinse mouth after using.

question

glipizide (Glucotrol) T/P

answer

T- Antidiabetic agent P- Sulfonylureas

question

glipizide (Glucotrol) MOA

answer

Lowers blood sugar by stimulating the release of insulin from the pancreas and increasing the sensitivity to insulin at receptor sites, may also decrease hepatic glucose production.

question

glipizide ( Glucotrol) indication of use

answer

Treatment of type 2 diabetes

question

glipizide ( Glucotrol) SE/AE

answer

Hypoglycemia, allergic reaction in those with sulfa allergies.

question

glipizide (Glucotrol) nursing considerations

answer

Monitor glucose and HbA1c levels, postprandial glucose levels, CBC with differential, liver and renal studies. Assess client for allergy to sulfa drugs. Teach- Watch for signs of hypoglycemia, follow prescribed diet, monitor glucose levels before meals and at bedtime, Do not use alcohol- has disulfiram like effects, use sunscreen, wear medic alert bracelet, report sore throat, unusual bruising, SOB, rash or hives IMMEDIATELY.

question

megestrol (Megace) T/P

answer

T-Antineoplastic P- hormone/progestin

question

megestrol (Megace) MOA

answer

Antineoplastic effect may result from inhibition of pituitary function. Progestin's increase appetite in those suffering from anorexia related to AIDS.

question

megestrol (Megace) indication of use

answer

Palliative treatment of endometrial and breast carcinoma, either alone or with surgery or radiation. (Tablet only )Treatment of anorexia, weight loss, and cachexia associated with AIDS (oral suspension only)

question

megestrol (Megace) SE/AE

answer

Thromboembolism-

question

megestrol (Megace) nursing considerations

answer

Assess client for swelling (usually unilaterally), pain, or tenderness in legs or armpit. Measure circumference and report these signs of deep vein thrombophlebitis. Any ovarian hormone may pose a risk for thrombophlebitis and embolus formation. Smoking increases the risk for thrombotic embolus formation. Teach client- take exactly as prescribed, report to HCP any unusual vaginal bleeding or signs of deep vein thrombophlebitis. May have teratogenic effects- contraception during therapy and at least 4 months after therapy. Possibility of hair loss.

question

lactulose (Cephulac) T/P

answer

T-laxative P- osmotic

question

lactulose (Cephulac) MOA

answer

Increases water content and softens the stool. Lowers the pH of the colon, which inhibits the diffusion of ammonia from the colon into the blood, reducing blood ammonia levels.

question

lactulose ( Cephulac) indication of use

answer

Treatment of chronic constipation in adults and geriatric clients. Used in diabetic clients with gastroparesis. Adjunct in the management of portal systemic encephalopathy (PCE).

question

lactulose (Cephulac) SE/AE

answer

Belching, cramping, distention and flatulence

question

lactulose (Cephulac) nursing considerations

answer

Assess client for presence of bowel sounds. Assess mental status before and throughout therapy. Monitor ammonia levels and glucose levels if diabetic. Monitor electrolytes- may cause diarrhea with resulting hypokalemia and hypernatremia. ( Loss of GI fluid from above the waist such as vomiting and suctioning causes a gain of base- leading to metabolic alkalosis, loss of GI fluid below the waist such as diarrhea will cause loss of base leading to metabolic acidosis. To administer enema use a rectal balloon catheter. Teach- increase bulk in diet, fluid intake and mobility.

question

oprelvekin (Neumega) T/P

answer

T-colony stimulating factors P- interleukins, thrombopoetic growth factors

question

oprelvekin (Neumega) MOA

answer

Stimulates production of megakaryocytes and platelets

question

oprelvekin (Neumega) indication of use

answer

Prevention of severe thrombocytopenia and reduction of the need for platelet transfusions following myelosuppressive chemotherapy in patients with nonmyeloid malignancies at risk for thrombocytopenia.

question

oprelvekin (Neumega) SE/AE

answer

Ventricular arrhythmias, atrial fibrillation, edema, palpitations, syncope, tachycardia, vasodilation.

question

oprelvekin (Neumega) nursing considerations

answer

Assess for signs of fluid retention. Monitor CBC and platelet count prior to and during therapy. HGB and HCT will decrease due to dilutional anemia ( 3-5 days after therapy has begun), then diminish. Monitor platelet count until postnadir count is greater than 50,000 cells. Monitor electrolyte concentration in those receiving chronic diuretic therapy- hypokalemia can be fatal. Teach- may cause transient blurred vision or dizziness, notify HCP if pregnancy is suspected, notify HCP if SOB, fatigue, blurred vision or irregular heart beat persists.

question

sildenafil ( Viagra) T/P

answer

T-Anti-impotence agent P- phosphodiesterase type 5 inhibitors

question

sildenafil (Viagra) MOA

answer

Enhance the effect of nitric oxide released during sexual stimulation. Nitric oxide activates guanylate cyclase, which produces increased levels of cGMP. Cyclic adenosine monophosphate produces smooth muscle relaxation of the corpus caverosum, which promotes increased blood flow and subsequent erection. PDE5 inhibitors improve lower urinary tract symptoms in BPH by increased blood flow and relaxation of smooth muscle in the prostate and the bladder.

question

sildenafil (Viagra) indication of use

answer

Treatment of erectile dysfunction. Symptoms of BPH

question

sildenafil (Viagra) SE/AE

answer

AE- sudden death, MI, cardiovascular collapse

question

sildenafil (Viagra) nursing considerations

answer

This causes vasodilation in the penis and in other areas of the body, do not give with other vasodilation medications. Teach- take as prescribed before sexual activity, do not take with other drugs unless HCP directs you to do so, erections lasting longer than 4 hours, or sudden decreased vision loss in one or both eyes must be reported immediately.

question

lisinopril ( Prinivil, Zestril) T/P

answer

T-Antihypertensives P- angiotensin- converting enzyme inhibitor (ACE)

question

Lisinopril (Prinivil, Zestril) MOA

answer

Block the conversion of angiotensin I to angiotensin II, potent vasoconstrictor. reduces the amount of aldosterone in the bloodstream.

question

Lisinopril ( Prinivil, Zestril) indications of use

answer

Management of HTN

question

Lisinopril (Prinivil, Zestril) SE/AE

answer

Angioedema, HA, cough

question

Lisinopril (Prinivil, Zestril) nursing considerations

answer

Always take BP prior to administration. Monitor I&O and daily weight. Monitor for signs of angioedema. Assess for signs of CHF. Monitor LFT, RFT, CBC, serum glucose and K+ Teach- Medication may cause drowsiness, notify HCP immediately if chest pain, palpitations, swelling of lips, face or tongue.

question

insulin glargine (Lantus) T/P

answer

T- antidiabetic agent, hormone P- pancreatic agents

question

insulin glargine (Lantus) MOA

answer

Lowers blood glucose by stimulating glucose uptake in skeletal muscle and fat; inhibits hepatic glucose production. Other actions include inhibition of lipolysis and proteolysis and enhanced protein synthesis.

question

insulin glargine (Lantus) indication of use

answer

Treatment of diabetes mellitus. Because of its delayed onset (1-2 hr) and prolonged duration it cannot be used in acute treatment of DKA.

question

insulin glargine (Lantus) SE/AE

answer

Hypoglycemia, anaphylaxis

question

insulin glargine (Lantus) nursing considerations

answer

Two nurses should check the insulin type, dosage, and expiration date. Rotate injection site. Monitor for hypoglycemia- cold and clammy skin basil insulins cannot be mixed. Teach- onset is (1-2 hr) if using a prefilled pen, prime with 2 units before dialing dosage. Recognize s/s of hypoglycemia and hyperglycemia. Carry a simple sugar or glucose tablets in case of hypoglycemia. Consult with HCP if feeling ill. Follow instructions for testing blood glucose levels.

question

NPH insulin ( Humulin N) T/P

answer

T-Antidiabetic agent P- Pancreatic enzyme

question

NPH insulin (Humulin N) MOA

answer

Lowering of blood glucose levels by stimulating glucose uptake in skeletal muscle and fat, inhibiting hepatic glucose production. Inhibition of lipolysis and proteolysis.

question

NPH insulin (Humulin N) indications of use

answer

Treatment of diabetes Intermediate suspensions have a onset of 1-2 hr and a peak of 4-12 hr Do not use in acute treatment of DKA.

question

NPH insulin (Humulin N) SE/AE

answer

Hypoglycemia, anaphylaxis

question

NPH insulin (Humulin N) nursing considerations

answer

Two nurses need to check insulin type, dosage and expiration date. Memorize peak times- hypoglycemia will happen at these times. Hypoglycemia- cold and clammy Teach- proper use of syringe and vials, test glucose and ketones- especially for sick care, carry a glucose source and wear medic alert bracelet, carb counting is useful, notify HCP if pregnancy is planned or suspected.

question

insulin asparte (Novolog) T/P

answer

T- antidiabetic agent P- pancreatic agent

question

insulin asparte (Novolog) MOA

answer

Lowers blood glucose by stimulating glucose uptake in skeletal muscle and fat, inhibiting hepatic glucose production. inhibition of lipolysis and proteolysis

question

insulin asparte (Novolog) indications of use

answer

Treatment of diabetes. These are very rapid acting agents with an onset of 5-15 minutes, with peak 30-60 minutes.

question

insulin asparte (Novolog) SE/AE

answer

Hypoglycemia and anaphylaxis

question

insulin asparte (Novolog) nursing considerations

answer

Two nurses need to check. "dose and eat" Hypoglycemia- cold and clammy Sick days require more monitoring. Carry a source of glucose. Wear a medic alert bracelet.

question

carbidopa/levodopa (Parcopa) T/P

answer

T-Anti-Parkinson agent P- dopamine agonist

question

carbidopa/levodopa (Parcopa) MOA

answer

Levodopa is converted to dopamine in the CNS, where it serves as a neurotransmitter. Carbidopa is a decarboxylase inhibitor, prevents peripheral destruction of levodopa

question

carbidopa/ levodopa (Parcopa) indication of use

answer

Treatment of Parkinson disease, not useful for drug induced extrapyramidal reactions.

question

carbidopa/ levodopa (Parcopa) SE/AE

answer

Involuntary movements, hepatotoxicity, drowsiness and dizziness.

question

carbidopa/levodopa (Parcopa) nursing considerations

answer

Assess BP and pulse frequently during period of dose adjustment. Monitor hepatic and renal function tests and CBC with differential. Assess for signs of toxicity. Teach client- GI irritation may be reduced by eating food shortly after taking medication- high protein meals may impair the drugs effects. May cause drowsiness and dizziness Change position slowly to decrease dizziness. Good oral hygiene and sugar free gum will help with dry mouth. Avoid multivitamins, Pyridoxine (vit B6) and iron may decrease effectiveness. Harmless darkening of urine or sweat may occur. Notify HCP if palpitations, urinary retention, involuntary movements, behavioral changes, severe nausea and vomiting, or new skin lesions occur.

question

alprazolam (Xanax) lorazepam ( Ativan) T/P

answer

T-Anti-anxiety agent, sedative hypnotic agent P- benzodiazepine

question

alprazolam (Xanax) lorazepam (Ativan) MOA

answer

Acts on many levels in the CNS to produce anxiolytic effect. May produce CNS depression. Effects may be mediated by GABA.

question

alprazolam (Xanax) lorazepam (Ativan) indication of use

answer

Anxiety, centrally acting muscle relaxer and adjunctive analgesic.

question

alprazolam (Xanax) lorazepam (Ativan) SE/AE

answer

Dizziness, drowsiness, lethargy, confusion, hangover, HA

question

alprazolam (Xanax) lorazepam (Ativan) nursing considerations

answer

Kava, valerian and chamomile can increase CNS depression. Assess degree and manifestations of anxiety during therapy. Monitor CBC with differential and liver and renal function. Plan to give more of your time to anxious client. Older clients may have increased hangover effect in morning and increased risk for falls. Avoid grapefruit juice Avoid the use of alcohol or other CNS depressants.

question

albuterol ( Proventil) salmeterol (Serevent) T/P

answer

T-bronchodilator P- adrenergic agent, beta 2 agonist

question

albuterol (Proventil) salmeterol (Serevent) MOA

answer

Binds to beta2 adrenergic receptors in airway smooth muscle, increases level of cAMP. Selective for beta 2 receptors in lungs. cAMP decreases action of myosin and Ca+ resulting in relaxation of smooth muscle.

question

albuterol (Proventil) salmeterol (Serevent) indication of use

answer

bronchodilation for control and prevention of reversible airway obstruction caused by asthma or COPD.

question

albuterol (Proventil) salmeterol (Serevent) SE/AE

answer

tremor, nervousness, HA, insomnia, chest pain, angina, HTN, arrhythmias and palpitations.

question

albuterol (Proventil) salmeterol (Serevent) nursing considerations

answer

Using this medication with MAOI may lead to HTN crisis. Observe for paradoxical bronchospasm ( wheezing). Monitor for palpitation and arrhythmias. Contact HCP immediately is SOB is not relieved by medication,. Bronchodilators before corticosteroids- wait 1 minute between inhalations of the same drug- wait 5 minutes between inhalations of different drugs- rinse mouth after.

question

Oxycodone/Acetaminophen ( Percocet) T/P

answer

T-opioid analgesics P-opioid agonists and nonopioid combinations.

question

oxycodone/acetaminophen (Percocet) MOA

answer

Binds to opiate receptors in CNS. Alters perception of and response to painful stimuli, while producing generalized CNS depression.

question

oxycodone/acetaminophen (Percocet) indication of use

answer

Management to moderate to severe pain.

question

oxycodone/acetaminophen (Percocet) SE/AE

answer

confusion, sedation, respiratory depression, N/V,

question

oxycodone/acetaminophen (Percocet) nursing considerations

answer

Assess pain level. Monitor plasma amylase and lipase. Naloxone is the antidote. Discontinue gradually after long term use. Administer with food or milk to minimize GI irritation. Change positions slowly to minimize dizziness. Avoid use of alcohol or other CNS depressants Good oral hygiene and sugarless gum or candy to decrease drymouth. Report constipation.

question

Acetaminophen ( Tylenol) T/P

answer

Antipyretics, non opioid analgesics

question

Acetaminophen (Tylenol) MOA

answer

Inhibits synthesis of prostaglandins that may serve as mediators of pain and fever primarily in CNS.

question

Acetaminophen (Tylenol) indication of use

answer

PO- mild pain, fever IV- mild to moderate pain- moderate to severe pain with opioid Fever

question

Acetaminophen (Tylenol) SE/AE

answer

hepatotoxicity- high doses

question

Acetaminophen (Tylenol) nursing considerations

answer

Assess pain and fever Evaluate hepatic, hematologic and renal function periodically during prolonged high dose therapies. Avoid alcohol.

question

ferrous sulfate ( Fer-iron) T/P

answer

T- antianemics P- iron supplements

question

ferrous sulfate (Fer-iron) MOA

answer

An essential mineral found in hgb, myoglobin and many enzymes. Enters the bloodstream and is transported to the organs of the reticuloendothelial system where it becomes part of iron stores ( liver, spleen, bone marrow).

question

ferrous sulfate (FER-IRON) indication of use

answer

treatment and prevention of iron deficiency anemia.

question

ferrous sulfate SE/AE

answer

dark stools, N/V, epigastric pain

question

ferrous sulfate nursing considerations

answer

assess bowel function for constipation. monitor hgb, hct and reticulocyte values.

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