Pharm Final Exam
What type of diuretic is hydrochlorothiazide?
thiazide diuretic
What kind of diuretic is furosemide?
loop diuretic
What kind of diuretic is spironolactone?
potassium sparing diuretic
Why are diuretics given and to what kind of patients?
given to lower blood pressure in patients who have fluid overload and congestive heart failure
What might diuretics cause?
orthostatic hypotension
Furosemide and hydrochlorothiazide may cause what?
hypokalemia
If your patient is taking furosemide or hydrochlorothiazide what levels should you be checking?
potassium levels
Spironolactone may cause what?
hyperkalemia
If your patient is taking furosemide what should you tell them to report and why?
ringing in the ear because it can cause ototoxicity
If your patient is taking furosemide what should you advise them to do and why?
limit sun exposure and wear sunscreen as it can cause photosensitivity
What is a side effect of antihypertensives?
hypotension
If your patient is taking antihypertensives what should you advise them to do and why?
change positions slowly because it can cause hypotension
What should you do before giving antihypertensives to your patient?
check their blood pressure and if low withhold the medication
What suffix do ACE inhibitors have?
pril
What type of medication are captopril, enalapril and lisinopril?
ACE inhibitors
What are side effects of ACE inhibitors?
hypotension, angioedema, hyperkalemia
ACE inhibitors are contraindicated in what kind of patients?
pregnant patients
What suffix do beta blockers have?
olol
What kind of medications are atenolol and metoprolol?
beta blockers
What is an adverse effect of beta blockers?
bradycardia
What must you check before giving beta blockers?
blood pressure and pulse rate
What are adverse effects of insulin and antidiabetic medications?
hypoglycemia
What should you advise your patient to do when taking antidiabetic medications or insulin?
take with food
What two types of insulin can you mix together?
NPH and regular
What is the only way insulin can be given?
via injections
If regular insulin is cloudy what should you do and why?
discard it because it should clear
A nurse is preparing to administer 10 units of regular insulin and 15 units of NPH insulin to a patient. What is the sequence of events you should follow?
inspect vials for contaminants, roll NPH vial between palms of hands, inject air into NPH insulin vial, inject air into regular insulin vial, withdraw short acting insulin into syringe, add intermediate insulin to syringe
If you need to give your patient 10 units of regular insulin and 15 units of NPH insulin, how many units are you giving in total?
25 units total
What kind of medication is digoxin?
antidysrhythmic
What are signs of symptoms of digoxin toxicity?
nausea, vomiting, anorexia, changes in vision, bradycardia
When should you withhold digoxin?
if your patient has bradycardia
What suffix do HMG-CoA reductase inhibitors have?
statin
What are two adverse effects of statins?
hepatotoxicity and myopathy
Patient's taking statins should avoid what kind of beverages?
grapefruit juice and alcohol
When is the best time to take statins?
evening or at bedtime
If your patient reports weak or sore muscles while taking statins what should you do?
withhold the medication and contact the healthcare provider
When administering nitroglycerin ointment what should you do and why?
avoid touching it by wearing gloves to avoid absorbing the medication through your skin
Where should you apply nitroglycerin transdermal patches?
hairless and clear area
How long should you remove nitroglycerin transdermal patches for and why?
10 to 12 hours to prevent tolerance
What should you advise your patient to do if they are taking nitroglycerin?
change positions slowly and rest feet on the floor for a few minutes before standing up
What is a common side effect of nitroglycerin?
throbbing headache
What kind of classifications are opioids?
high alert drugs and controlled substances
What can opioids do to a patient?
lower blood pressure, heart rate and respiratory rate
What are side effects of opioids?
nausea and vomiting and constipation?
If your patient is taking opioids what side effect should you educate them on?
constipation so advise them to eat foods with high fiber if it doesn't help you may give laxatives
What is the antidote of opioids?
naloxone
What kind of medication are acyclovir and valacyclovir?
antivirals
What should you ask your patient before giving acyclovir?
if they have an allergy to milk
What is the treatment for a patient with HIV?
antiretroviral therapy
If your patient is taking antiretrovirals for HIV and is pregnant what should you advise them to do?
continue taking antiretroviral as prescribed throughout entire pregnancy to prevent transmission to the baby
If your patient is taking acetaminophen what should you advise them to avoid?
alcohol, other hepatotoxic drugs and over the counter cold medications
What are signs and symptoms of acetaminophen toxicity?
nausea and vomiting, abdominal pain, sweating, and diarrhea
What is the antidote of acetaminophen?
acetylcysteine
Why do you give anticoagulants?
to prevent clot formation
What is a dangerous adverse effect of anticoagulants?
bleeding
What are signs and symptoms of bleeding?
gum and nose bleeding, black tarry stool, tachycardia
If your patient is taking heparin or warfarin what should you advise them to use?
soft toothbrush
If your patient is taking heparin what should you be frequently be checking?
aPTT
What is the antidote of heparin?
protamine sulfate
What should you be checking if your patient is taking warfarin?
PT and INR
What is the antidote of warfarin?
Vitamin K
Why is heparin only given via injection?
it can not be absorbed PO
If your patient is taking warfarin what should you advise them to avoid?
foods high in vitamin K
What is an adverse effect of heparin?
Heparin induced thrombocytopenia (HIT)
What does epoetin alfa treat?
anemia
If your patient is taking epoetin alfa what else should they be taking for it to work?
iron supplements
What does filgrastim do?
stimulates formation of white blood cells
What should you monitor when taking filgrastim?
white blood cells twice a week
When you withdraw a dose of filgrastim from a vial what should you do with the rest?
discard the entire vial after one use
What is are side effects of filgrastim?
splenomegaly and bone pain
What is Parkinson's disease?
low levels of dopamine in the brain
What are symptoms of Parkinson's disease?
stooped posture, masked face, tremors, shuffling gait, back rigidity
How do you know if medications for Parkinson's are working?
the patient experiences less tremors and rigidity
What are adverse effects of insulin and antidiabetic medications?
hypoglycemia
What should you warn your patient about when taking carbidopa and levodopa?
it may turn urine and saliva into a dark color
What should patients avoid when taking MAO inhibitors and why?
foods that contain tyramine because it can cause severe high blood pressure
What are examples of food that contain tyramine and should be avoided by patients taking MAO inhibitors?
cheddar cheese, aged cheeses, avocado, sourdough bread, beer, red wine
What type of medication is Bupropion and what else can it be used for?
it is an antidepressant that is also used for smoking cessation
How do you know bupropion is working when being taken for smoking cessation?
decreased urge to smoke
What are signs and symptoms of hypothyroidism?
slow heart rate, slow respiration rate, always feels cold, weight gain, constipation, always tired
What medication is used to treat hypothyroidism?
levothyroxine
What are signs and symptoms of levothyroxine overdose?
tachycardia, tachypnea, nervousness, sweating, insomnia
What are signs and symptoms of hyperthyroidism?
tachycardia, tachypnea, nervousness, sweating, intolerance to heat, weight loss, protruding eyes, diarrhea
What medications are used to treat hyperthyroidism?
methimazole and propylthiouracil
What might methimazole and propylthiouracil cause?
agranulocytosis (decreased number of white blood cells)
What medication is used to treat osteoporosis?
alendronate
What should you advise your patient to do when taking alendronate?
take with a full glass of water and remain sitting or standing for at least 30 minutes after taking it and don't take with milk or dairy
What are adverse effects of alendronate?
jaw pain, blurred vision and dysphagia
What are signs and symptoms of menopause?
hot flashes, depression, swinging moods, osteoporosis
What can help treat symptoms of menopause?
hormone replacement therapy like medroxyprogesterone and conjugated estrogens
What are side effects of medroxyprogesterone and conjugated estrogens?
increased risk of cervical cancer and clot formation
What kind of medications are fluoxetine and paroxetine?
selective serotonin reuptake inhibitors (SSRIs)
What should you tell your patient that is about to take SSRIs?
they make take 3-6 weeks to work so continue taking them
What is an adverse effect of SSRIs?
increased risk of suicide within the first few weeks and sexual dysfunction
What are the positive symptoms of schizophrenia?
hallucinations, delusions, disordered thinking
What are negative symptoms of schizophrenia?
lack of motivation, lack of personal hygiene, lack of social interest
How do you know if treatment for schizophrenia is working?
decreased hallucinations, better personal hygiene, better social interaction
What does haloperidol treat?
schizophrenia
What is an adverse effect of haloperidol?
pseudo parkinsonism
What are signs and symptoms of pseudo parkinsonism?
shuffling gait, tremor, stooped posture
What are signs and symptoms of neuroleptic malignant syndrome?
fever, muscle rigidity, unstable blood pressure, dilated pupils
What kind of medications are risperidone and quetiapine?
atypical antipsychotics
What should you advise your patient to do if they are taking atypical antipsychotics and why?
check their weight because they can cause weight gain
What do benzodiazepines cause?
sedation and drowsiness
What suffix do benzodiazepines have?
pam or lam
What kind of medication is lorazepam?
Benzodiazepine
When should you withhold benzodiazepines?
if your patient is experiencing increased anxiety (paradoxical excitement)
What is lithium used to treat?
bipolar disorder
What is bipolar disorder?
episodes of mania and depression
What are signs and symptoms of lithium toxicity?
tremor, slurred speech, nausea and vomiting
You should you make sure your patient has enough intake of in their diet when taking lithium?
sodium
Aspirin increases the risk of what?
GI bleeding
What can be a contraindication for aspirin?
history of vitamin K deficiency
What is salicylism?
aspirin toxicity
What are signs and symptoms of salicylism?
fever, tinnitus, headache, sweating, dizziness, respiratory depression
What patients should you not give aspirin to and why? What should you give them instead?
young children because it can cause Reye's syndrome so acetaminophen should be given instead
How do first generation antihistamines work?
they reach the brain and cause sedation and drowsiness
What are examples of first generation antihistamines?
chlorpheniramine and promethazine
When should you take first generation antihistamines?
at bedtime because they cause sedation and drowsiness
What are examples of second generation antihistamines?
loratadine, fexofenadine, cetirizine
What generation of antihistamines won't make you drowsy?
second generation
What suffix do proton pump inhibitors (PPI) have?
prazole
When is the best time to take proton pump inhibitors (PPI)?
once a day usually 30-60 minutes before breakfast
What are side effects of proton pump inhibitors (PPI)?
increased risk of pneumonia, osteoporosis, photosensitivity
What kind of medication is prednisone?
Corticosteroid
What should you be checking often in a patient that is taking corticosteroids?
blood sugar levels because they can be increased
What suffix do penicillin's have?
cillin
What is an adverse effect of penicillin?
anaphylaxis
What are signs and symptoms of anaphylaxis?
swelling of lips and tongue, difficulty breathing, low blood pressure
What is the treatment for a patient experiencing anaphylaxis?
epinephrine injection subcutaneously
What medications are used to treat tuberculosis?
isoniazid, pyrazinamide, rifampin, ethambutol
How long should patients take medications to treat tuberculosis?
9-12 months
What should you check before giving treatment for tuberculosis and why?
liver function because the medications are hepatoxic
What can rifampin cause?
orange urine, saliva and other body secretions
Your patient develops urticaria, rash and itching during blood transfusion. What is your priority action?
stop the transfusion
What should you give to a patient that is experiencing an asthma attack?
short acting beta2 agonists
What suffix do short acting beta2 agonists have?
buterol
What are contraindications for receiving the varicella vaccine?
pregnancy, immunocompromised, allergy to gelatin and neomycin
What age should a patient receive the meningococcal conjugate polysaccharide vaccine (MCV 4)?
age of 6-12 and a booster at age 16
Who can receive yearly flu vaccines?
everyone including pregnant patients
Who can receive live attenuate influenza vaccines?
patients between the ages 2 and 50
Who can not receive the live attenuate influenza vaccine?
children 2-17 who are taking aspirin, patients who are taking antiviral medication, patients under the age of 2 and patients over the age of 50, and patients that are pregnant
What age should the measles, mumps and rubella (MMR) vaccine be given?
12-15 months and booster at age of 4-6 years
How should you take carbidopa and levodopa?
on an empty stomach but if discomfort is experienced they may be taken with applesauce
What are adverse effects of insulin and antidiabetic medications?
hypoglycemia