Studies of Nursing Pharmacology Quiz 2

❖ Chapter 5 – 9 questions ⮚ Idiosyncratic ▪ The nurse administers zolpidem (Ambien) to a client at 11 p.m. for sleep. The client awakens at 3 a.m. and is wide awake and agitated. How will the nurse document this client's reaction to the medication in the medical record? 1. Allergic response 2. Side effect 3. Adverse effect 4. Idiosyncratic reaction ● Answer: 4 Explanation: The desired response of Ambien is sleep induction. An opposite or unexpected reaction would be an idiosyncratic reaction. ▪ The nurse determines that an idiosyncratic reaction to a drug has occurred when the client experiences drug effects that have which characteristic? 1. Predictable 2. Unexplained 3. Irreversible 4. Life threatening ● Answer: 2 Explanation: Idiosyncratic drug reactions are those that are unexpected or unexplained. ⮚ Teratogenic? Toxic to who? Pregnant? (slide 27) ▪ A client is prescribed a medication and is concerned it might have teratogenic effects. Which response by the nurse is the most appropriate? 1. "Let me check the pregnancy risk category of the drug." 2. "Are you in your first trimester of pregnancy?" 3. "If your healthcare provider ordered the medication, it should be okay." 4. "You should avoid taking any medications while pregnant." ● Answer: 1 Explanation: The pregnancy risk category of a drug gauges the risk of birth defects or teratogenic effects. ⮚ Chemo therapeutic drugs ▪ A client is prescribed a chemotherapeutic drug for treatment of leukemia and asks the nurse why a drug that can also cause cancer is being used to treat cancer. Which response by the nurse is the most appropriate? 1. "The incidence of carcinogenic effects is really quite small, and you shouldn't be concerned about it." 2. "Since you are receiving such potent drugs, they have to warn of you of every possible side effect." 3. "The risk for causing another cancer is there, but sometimes the benefit of the treatment outweighs the risks." 4. "The carcinogenic effects often do not show up for a few decades, and we want to cure this leukemia now." ● Answer: 3 ● Explanation: The benefits of treatment sometimes do outweigh the risks; this provides an honest answer to the client. ⮚ Hepatoxicity; liver function test (slide 32) ▪ The nurse determines that the client is most at risk for renal toxicity while receiving an aminoglycoside anti-infective when which diagnostic lab result is abnormal? 1. Kidney function test 2. White blood cell count 3. Liver function test 4. Platelet count ● Answer: 1 Explanation: Abnormal kidney function tests would indicate kidney impairment. ▪ A client on long-term therapy with itraconazole (Sporanox) for treatment of a nail fungus is admitted to the hospital with right upper quadrant pain, nausea, and abdominal pain. Which laboratory results found in the medical record would support the diagnosis of hepatotoxicity? 1. Elevated liver function tests 2. Elevated creatinine levels 3. Decreased blood sugar 4. Decreased prothrombin time ● Answer: 1 Explanation: Elevated liver function tests, which include the enzymes ALT and AST, are indicative of liver inflammation and/or impaired function of the liver. ⮚ Dermatologic toxicity (slide 31) ▪ The nurse plans to monitor a client for dermatologic toxicities after administering which medication? 1. Salicylates 2. Antiseizure drugs 3. Antithyroid drugs 4. Loop diuretic ● Answer: 2 Explanation: Antiseizure drugs are associated with dermatologic toxicity. ▪ A nurse is caring for a client recently prescribed an oral antibiotic who is exhibiting signs of dermatologic toxicity. Which assessment findings support dermatologic toxicity? ♦ Select all that apply. 1. Rash 2. Itching 3. Urticaria 4. Sunburn 5. Photosensitivity ● Answer: 1, 2, 3, 4 Explanation: Rash is a common hypersensitivity response. Itching is a common hypersensitivity response. Hives are common in a hypersensitive response. Certain drugs can cause the skin to be sensitive to the sun, resulting in sunburn. ⮚ Bone Marrow toxicity (slide 29) ▪ A nurse is planning care for a client taking a medication with the potential to cause bone marrow toxicity. Which interventions exemplify the nurse's role in preventing complications? ● Select all that apply. 1. Assess the client for signs and symptoms of infection. 2. Assess the client for signs and symptoms of anemia. 3. Monitor the client for signs and symptoms of fatigue. 4. Monitor the client for evidence of bruising. 5. Monitor the client for insomnia. ● Answer: 1, 2, 3, 4 Explanation: Bone marrow toxic drugs can affect the production of white blood cells. Bone marrow toxic drugs can affect the production of red blood cells. Bone marrow toxic drugs can affect the production of red blood cells. Bone marrow toxic drugs can affect the production of platelets. ⮚ Food drug interactions (slide 38) ▪ When checking on the potential interactions of two drugs being administered at the same time, the nurse recognizes which principle? 1. Drug—drug interactions are more serious than drug—food interactions. 2. All drugs will have some type of interaction. 3. Drug interactions should always be avoided. 4. Some drug interactions can produce therapeutic effects. ● Answer: 4 Explanation: The combination of some drugs can produce a synergistic or additive effect, which often is therapeutic in nature. ▪ The nurse recognizes that which food on a client's tray could cause a drug—food interaction with warfarin (Coumadin)? 1. Banana 2. Toasted cheese sandwich 3. Iced tea 4. Spinach salad ● Answer: 4 Explanation: The vitamin K in the spinach can interfere with the action of warfarin (Coumadin) and prolong bleeding time. ▪ The nurse administers ciprofloxacin (Cipro), a fluoroquinolone, to a client. To prevent a food—drug interaction, the nurse should remove which item from the client's lunch tray? 1. Orange juice 2. Tomatoes 3. Coffee 4. Chocolate cake ● Answer: 3 Explanation: Cipro may increase the stimulatory effects of caffeine. ▪ The nurse is conducting medication teaching for a client recently prescribed a calcium channel blocker. Which food will the nurse caution the client to avoid when taking this medication? 1. Grapefruit and grapefruit juice 2. Coffee 3. Dairy products 4. Green, leafy vegetables ● Answer: 1 Explanation: Grapefruit can enhance the absorption of calcium channel blockers, leading to elevated drug levels. ▪ A nurse is reinforcing discharge instructions concerning food—drug interactions. Which statements by the client indicate correct understanding of the discharge instructions? ♦ Select all that apply. 1. "I should take my medications with water to avoid any problems with my medications being absorbed." 2. "I cannot take one of my medications with grapefruit juice because it will decrease the absorption of the medication." 3. "I need to be sure to read the prescription label because the pharmacist will indicate if I need to take my medication with food or without food." 4. "I should take my daily vitamin 2 hours after my medication so they do not affect each other." 5. "If I take my medication with hot tea, it will not affect absorption." ● Answer: 1, 2, 3, 4 ● Explanation: The safest fluid to take with medications is water. Grapefruit juice can increase absorption of certain drugs and should be avoided. The pharmacist will indicate on the medication label if the medication should be taken with or without food. Herbal supplements and vitamins can cause adverse effects when taken with medication. ⮚ Tetracycline; teachings for patient to avoid? Avoid Milk? ▪ A client is prescribed tetracycline for an infection. The nurse instructs the client to avoid which food to prevent a possible drug—food interaction? 1. Citrus juices 2. Dairy products 3. Legumes 4. Beef ● Answer: 2 Explanation: The calcium in dairy products can interfere with the absorption of tetracycline, and so should not be taken with the medication. ▪ A client is prescribed tetracycline for acne. Which foods should the nurse ask the client to avoid while taking this medication? ● Select all that apply. 1. Milk 2. Almonds 3. Ice cream 4. Hamburgers 5. Grapefruit juice ● Answer: 1, 3 ● Explanation: Milk products contain calcium, which will decrease absorption. Milk products contain calcium, which will decrease absorption. ⮚ What patient population excretion happens? What disease process excretion in population? Renal? ▪ The nurse would anticipate an alteration in drug excretion in clients with which conditions?. ● Select all that apply. 1. Kidney disease 2. Heart disease 3. Diarrhea 4. Asthma 5. Alzheimer's disease ● Answer: 1, 2 ● Explanation: Any condition that decreases or impairs glomerular filtration rate will decrease excretion of drugs from the body. Glomerular filtration rate is directly related to cardiac output. Any heart disease that decreases cardiac output will decrease excretion of drugs from the body. Review info Chapter 4 Pharmacodynamics (Slide 5) o Pharmaco = medicines o Dynamics = change o How a drug changes the body o Involves drug mechanism of action o Involves effect of drug concentration on body responses Individuals have different responses to drugs (Slide 7) o Responses are related to: o Dose‒response relationships o Therapeutic index o Drug receptor interactions Frequency distribution curve o Number of patients responding to a drug action at different doses o Horizontal axis shows range of responses. o Peak curve shows largest response. Median effective dose (ED50) (Slide 10)  Desired drug response in 50% of subjects o Clinical implications  Average dose predicts therapeutic response in 50%  Client may need less or more of a drug.  Need to monitor drug effect on client  Dosage adjustment may be indicated. The therapeutic index describes a drug's margin of safety. (Slide 11)\ Identifies safety index of drugs o Median lethal dose (LD50)  Lethal to 50% of test subjects o Therapeutic index (TI)  Ratio of a drug's median lethal dose (LD50) to its median effective dose (ED50) Agonists, partial agonists, and antagonists compete for cellular receptors and can modify drug action. (Slide 28) Agonists(Slide 29) o Mimic the action of endogenous substances o Response may be greater than endogenous activity. o Partial agonists  Produce weaker action than endogenous substances Antagonists (Slide 30) o Prevent action of endogenous substances o May compete with agonists o Useful in blocking excess endogenous activity o May reverse adverse effects of overdoses o Antagonists do NOT have intrinsic activity. o Functional antagonism inhibits the effects of an agonist Review Info Chapter 5 Adverse Drug Effects (Slide 21) o Drug classes most likely to cause allergic reactions o Penicillin and related antibiotics o Radiologic contrast media with iodine o Insulin o NSAIDs o Sulfonamides o Cancer chemotherapy agents o Preservatives o Certain antiseizure drugs Adverse Drug Effects (Slide 22) o iosyncratic reactions are unusual drug responses often caused by genetic differences among patients. o Idiosyncratic reactions  Unusual or unexpected responses  Unrelated to pharmacological action of drug  Rare  Unpredictable  Vary in individual clients Teratogens (Slide 27) o Potential to cause birth defects o Only used in pregnancy when benefit clearly outweighs risk o Drugs not tested in pregnant women o Drug should be identified as safe for use in pregnancy. Bone marrow toxicity (Slide 29) o Often is serious or life-threatening o Pancytopenia o Aplastic anemia o Agranulocytosis and neutropenia o Frequently associated with antineoplastics Dermatologic toxicity (Slide 31) o Skin reactions are common adverse effects. o Rash with pruritis common o Urticaria may lead to anaphylaxis. o Angioedema and SJS are serious reactions and may be fatal. o Phototoxicity Hepatotoxicity (Slide 32) o Liver detoxifies majority of drugs. o Hepatotoxicity common adverse effect o Monitor liver enzyme tests with hepatotoxic drugs. o Signs of liver impairment can be vague. o Severe liver impairment can cause toxic drug levels. Drug interactions may significantly affect pharmacotherapeutic outcomes Types of interactions (Slide 38)  Drug‒drug  Drug‒food o Occur continually o Often go unnoticed o May or may not be harmful Mechanisms (Slide 39) o Classified by effect on drug action o Inhibition o Decreases therapeutic action o Enhancement o Provides greater therapeutic action o Change in drug response Pharmacokinetic drug interactions include changes in the absorption, distribution, metabolism, or excretion of medications. Pharmacodynamic drug interactions include additive, synergistic, or antagonistic effects (Slide 48, 49) o Pharmacodynamic drug interactions  Drug action enhanced or inhibited  Interactions can be desirable.  Increased therapeutic response  Decreased adverse effects  Interactions can be undesirable.  Decreased therapeutic responses  Increased adverse effects o Types  Additive effect  Combined summation response  Synergistic effect  Enhanced response from combined drugs  Antagonistic effect  Diminished response occurs. o Although many substances can be considered drugs, which drug definition is the most appropriate? o Any substance that is taken to prevent, cure, or reduce symptoms of a medical condition Which principle best describes what nurse is expected to understand when administering to a client? o The pharmacotherapeutics for all of the medications The physician has written an order for a client for a client for a new antihypertensive drug. Why is it important for the nurse to have an understanding of the drug's prototype? o Knowledge of the prototype allows the nurse to surmise important about an unfamiliar drug in the same class - Knowledge of the prototype drug's therapeutic or pharmacologic classification can offer useful information about the unfamiliar drug - If the nurse knows the actions and adverse effects of the prototype drug, this information can be relevant to use of the unfamiliar drug A client tells the nurse that the healthcare provider has prescribed a new medication that "has just come on the market." The nurse has not heard of this particular medication but is able to give the client important information based on its prototype drug because of which principles? o The information regarding the prototype drug can be extended to any drug in the same class Knowing the prototype drug allows the nurse to predict the mechanism of action of the new medication The prototype drug is the drug to which all drugs in a class are compared Knowing the prototype drug's therapeutic classification can reveal important information about other drugs in the same class A prototype drug is a single drug in a class and can be compared with all other medications in the class. By studying a prototype drug, the nurse would gain what knowledge for predicting the characteristics of other drugs in the same class? o The drug's actions and adverse effects The drug's specific clinical use The drug's therapeutic indications he nurse is creating a teaching plan for a client on the cardiac unit and is researching medications the client is currently taking to understand how each drug produces its effects in the body. To find this information, the nurse looks up which classification for each medication? o Pharmacologic Which principle best describes what the nurse is expected to understand when administering medication to a client? a. the pharmacotherapeutics for all of the medications that the client is recieving b. the most common side effects of the drug's prototype c. the trade and generic names for all of the medications d. the cost of the drug therapy a. the pharmacotherapeutics for all of the medications that the client is recieving