PHARMACOLOGY

Pharmacology - most simply defined as study of drug. Fundamentals of Pharmacology 1. Pharmacokinetics - study of drug’s changes as it enters and passes through the body. a. absorption b. distribution c. biotransformation d. excretion 2. Pharmacodynamics - mechanism by which drugs produce changes in body tissue. a. desired effect - intended action of drugs b. adverse effect - harmful unintended reactions c. side effects – consequence reactions d. toxicity – the degree which something is poisonous digoxin = 0.5 – 2.0 ng/mL lithium = 0.5 – 1.5 mEq/L Safety and Efficacy Nursing Principles : 1. Always verify the Five Rights . a. the right medications b. the right client c. the right dosage d. the right form, route and technique e. the right time 2. Chart drug administration only after its been given, never before. 3. Never leave the medication on cart or tray unattended. 4. Chart observed therapeutic and adverse effects accurately and fully. 5. Check history for allergies and potential drug interactions before administering a newly ordered drug. 6. Inform the prescribing physician of any observed adverse effects; if cannot be located, inform the nursing supervisor 7. Question drug orders that are unclear, that appear to contain errors, or that have potential to harm. 8. Take the following actions if an error occurs : a. immediately notify the nursing supervisor, the prescribing physician, and the pharmacist. b. assess the client’s condition and provide any necessary care. 9. For postpartum women, advice to take drugs after breastfeeding. Administration of Drugs : Routes and Nursing considerations: 1. Enteral – oral, sublingual, rectal, gastric tubes

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- capsulated pill, sustained release and enteric coated should not be crushed. 2. Parenteral – IV, IM, SQ, ID, IT, IA, epidural. - vastus lateralis (safest site for IM) 3. Topical – skin, inhalants, mucus membrane. Eye medications : - administer eyedrops first then ointment. - use a separate bottle for each client. - instruct the client to tilt the head backward, open eyes and look up. - avoid contact of medication bottle to the eyeball. - place prescribed dose in the lower conjunctival sac. - instruct the client to press the inner canthus for 30-60 seconds. - instruct the client to close the eye gently. Ear drops - in infant and children younger than 3 y.o, pull pinna downward and backward. - in older children and adult, upward and backward. - direct the solution on the wall of the ear canal, not directly on the ear drum.

CLASSIFICATIONS OF DRUGS
DRUGS AFFECTING THE CENTRAL AND AUTONOMIC SYSTEM Cholinergic Agents (Parasympathomemitics) Prototype : - synthetic acetylcholine, pilocarpine, carbachol, bethanecol (Urocholine), edrophonium (Tensilon), neostigmine (Prostigmine), pyridostigmine (Mestinon). Mechanism of action : - stimulates cholinergic receptors by mimicking acetylcholine or inhibition of enzyme cholinesterase. Indications : - glaucoma, urine retention, Myasthenia Gravis - antidote to neuromuscular blocking agents : tricyclic antidepressants and atropine Adverse effects : - blurring of vision, miosis - increase in salivation, intestinal cramps - bronchoconstriction, wheezing, DOB - hypotension and bradycardia Nursing considerations : 1. Warn & monitor clients of the side effects. 2. Have atropine available for use as antidote.

Cholinergic Blocking Agents (Parasympatholytics, Anticholinergics)
Prototype : ______________________________________________________________

atropine, scopalamine (Triptone), dicyclomine (Bentyl), propantheline (Pro-Banthine). Mechanism of actions : - block the binding of acetylcholine in the receptors of parasympathetic nerves. Indications : - use preoperatively to dry up secretions. - treat spasticity of GI or urinary tract. - use for treatment of bradycardia, asthma, parkinsonism. - use for antidote in organophosphate poisoning. Adverse effects : - dry mouth , dilatation of pupils, tachycardia - urinary retention, ileus, heat stroke Nursing considerations : 1. Keep client’s in cool environment. 2. Watch out for signs of heatstroke and dehydration. 3. Encourage clients to increase fluid intake and use of sugarless gum/candy for dry mouth. 4. For GI spasticity, administer 30 minutes before meals and at bed time. Adrenergic Agents (Sympathomimetics) Prototype : - epinephrine, norepinephrine, ephedrine, dopamine, dobutamine, phenylephrine, terbutaline, albuterol, isoproterenol. Mechanism of actions : - stimulate alpha and beta adrenergic receptor directly or trigger the release of catecholamines indirectly causing sympathetic effects. Indications : - cardiopulmonary arrest, hypotension - COPD and asthma, nasal congestions - allergic reaction, anaphylactic shock Adverse effects : - restlessness, insomnia, tremors, nausea - palpitations, angina, tachycardia, HPN Nursing considerations : 1. Contraindicated in clients w/ hyperthyroidism, pheochromocytoma & cardiovascular disease. 2. Monitor vital signs and advice precautions. 3. Should be taken with food.

ADRENERGIC BLOCKING AGENTS
Prototype : a. Alpha blockers - phentolamine (Regintine), phenoxybenzamine, prazosin (Minipress), reserpine (Serpasil), terazosin (Hytrin) - clonidine (Catapress), methyldopa (Aldomet) b. Beta blockers - atenolol (Tenormin), esmolol (Brevibloc), metoprolol (Lopressor), nadolol (Corgard), propanolol (Inderal), timolol ( Blocadren) Mechanism of actions : a. alpha blockers ______________________________________________________________

Adverse effects : .for muscle spasticity associated with multiple sclerosis. if insomnia occurs. ANTICONVULSANTS ______________________________________________________________ . Warn clients not to drive or operate dangerous machinery until he/she has adjusted to medications. Inform clients that maximum benefit of baclofen is attained for 1-2 months. depression. CVA. .compete with epinephrine in b-receptors in heart. Administer oral alpha-blockers with milk to minimize GI side effects. b. 5.for acute musculoskeletal pain . bradycardia. 4. bradycardia. bowel and bladder functions. pheochromocytoma.. ataxia. cold extremities Nursing considerations : 1. 3. Skeletal Muscle Relaxants Agents Prototype : . refer if below 60 bpm. cerebral palsy. Check client’s apical pulse rate before drug administration.angina. hallucinations. 4. drowsiness . 2. arrhythmias. beta blockers . nasal stuffiness.depress CNS . Caution clients that mental alertness may be impaired. Reduce baclofen dosage gradually because of associated withdrawal symptoms : Confusion. hypotension. Indications : .blurred vision.inhibit calcium ion release in the muscle . dantrolene (Dantrium).depression. insomnia and vertigo .bronchospasm and dyspnea. chlorzoxazone Mechanism of actions: .enhance the inhibitory action of GABA (gamma-amino butyric acid) Indications : .methacarbamol (Robaxin). Hypotensive precautions. orphanedrine (Norgesic).hypotonia. CHF . Monitor neuromuscular status. mitral valve prolapse. glaucoma Adverse effects : .orthostatic hypotension. peripheral circulation and CNS. urine retention Nursing considerations : 1. baclofen (Lioresal). 2. pulmonary airways. hypertension. Administer oral beta-blockers before meals and at a. 3. metaxalone (Skelaxin). and spinal cord injury. paranoia & rebound spasticity.m.Raynaud’s disease.inhibits action of a-receptors in vascular smooth muscle to cause vasodilatation.

Warn clients with diabetes that hydantoins may increase blood sugar level and that valproic acid may produce a false positive result in urine ketone test. benztropine (Congentin) b. dopaminergic agents . Inform clients taking phenytoin that harmless urine discoloration is common. 8.trihexyphenidyl (Artane). clorazepate (Tranxene). nystagmus. 7.inhibit cerebral motor centers. Avoid taking alcohol with barbiturates. Advise female clients to use contraceptives. bromocriptine.Prototype : a. selegiline (Eldepryl). 6. tachycardia Nursing considerations : 1. dark-colored urine and sweat b. Mechanism of actions : a.diplopia. aplastic anemia Nursing considerations : 1. Give dopaminergic agents after meals to reduce GI symptoms. Prototype : a.sedation & drowsiness. pergolide (Permax). Teach clients receiving carbamazepine to identify symptoms of bone marrow depressions. Adverse effects : . Miscellaneous . Adverse effects of dopaminergic agents: a. Dopaminergic agents . diazepam. levodopa – nausea. anorexia.Levodopa. vomiting.treat seizures by depressing abnormal neuronal activity in motor cortex. gingival hyperplasia . ethosuximide (Zarontin). anticholinergic agents . Hydantoins . Avoid mixing other drugs in same syringe with phenytoin. 3. 2. ______________________________________________________________ ANTIPARKINSONIAN AGENTS . b. Mechanism of action : . orthostatic hypotension.carbamazepine (Tegretol). bromocriptine – palpitations. Anticholinergic agents . constipation c. amantidine (Symmetrel). valproic acid (Dapakene).thrombocytopenia.phenytoin (Dilantin) b. amantidine – ankle edema. Administer IV phenytoin slowly to avoid cardiotoxicity.phenobarbital ( Luminal) c. carbidopa-levodopa (Sinemet). Reassure that barbiturates are not addictive at a low dosage. dizziness . vertigo. 4.increasing dopamine concentrations or enhancing neurotransmitter functioning. 5. Barbiturates .

drug-induced respiratory depressions. Watch out for growth retardation in children taking methylphenidate. CNS depression .diazepam (Valium). Monitor blood pressure and pulse. CENTRAL NERVOUS SYSTEM STIMULANTS Prototype : .respiratory depression.2. drug-dependence Nursing considerations : ______________________________________________________________ .attention deficit hyperactivity disorders . DRUGS AFFECTING MENTAL FUNCTIONING Sedatives. flurazepam (Dalmane) b. methylphenidate (Ritalin) Mechanism of actions : . 4. Ice chips or sugarless gum for dry mouth.depress CNS Indications : . Nursing considerations : 1. Hypnotics. insomnia. lorazipam (Ativan). tachycardia. Reassure client that levodopa may cause harmless darkening of urine and sweat. Educate clients to minimize orthostatic hypotension. paraldehyde (Paral) Mechanism of actions : a.increase the effect of inhibitory neuro transmitter GABA (gamma-amino butyric acid) b. 4. Adverse effects : .induce sleep.hypertension.narcolepsy . phenobarbital. Don’t stop amphetamine abruptly to avoid withdrawal symptoms.nervousness. headache .anorexia. Benzodiazepines . Barbiturates and Miscellaneous agents . Barbiturates . Indications : . 3. buspirone (Buspar). sedate and calm clients Adverse effects : .amobarbital. alprazolam (Xanax). Should be given at morning. Avoid taking Vit B6 (pyridoxine) with levodopa because it speed up metabolism. 5. and Anxiolytics Prototype : a.chloral hydrate (Noctec). Benzodiazepines .amphetamines.hangover-effect. dizziness. Miscellaneous . 3. 5. Elevate leg to reduce ankle edema.increase excitatory CNS neurotransmitter activity and blocks inhibitory impulses.for obesity (amphetamines) . restlessness . secobarbital c. dry mouth. 2.

wine.inhibit the enzyme MAO that metabolize the neurotransmitters norepinephrine and serotonin. 3. Caution client to rise slowly to reduce the effects of orthostatic hypotension. Lithium Mechanism of actions : a. Warn clients of injuries and falls.aged cheese. Brief period of confusion and excitement upon waking up is common with benzodiazepines. tranylcypromine (Pernate) c. Nursing considerations : 1. desipramine b. 7. MAO (monoamine oxidase inhibitors ) .dehydration (Lithium).orthostatic hypotension. blurred vision. . soy sauce and yeast .pentholamine (Regintine) is the drug of choice for hypertensive crisis.fluoxetine (Prozac). Take antidepressant with food to enhance absorption 3. 6. MAO inhibitors . Rotate and don’t shake the ampules of barbiturates. Second-generation antidepressants . phenelzine (Nardil).increase receptor sensitivity to serotonin and/or norepinephrine. Don’t mix with other drugs. urine retention. Assess client for constipation resulting from tricyclic antidepressant use. .amitriptyline (Elavil). Second – generation antidepressants . trazodone (Desyrel) d. Explain to client that full response may take several weeks (2 weeks). yogurt. 5. Warn clients not to discontinue medications abruptly without consulting a physician. Avoid alcohol while taking these drugs. beer. 2. Warn female clients that diazepam is associated with cleft lip.dry mouth. constipation (anticholinergic effects) . d.imipramine (Tofranil).1. 4.hypertensive crisis (MAO) . b.isocarboxazid (Marplan). Lithium . protriptyline (Vivactil). Client taking MAO inhibitors should avoid tyramine-rich foods to avoid hypertensive crisis. chocolate. ______________________________________________________________ . 2.inhibits the reuptake of serotonin. sour cream. 4.increase serotonin & norepinephrine uptake Adverse effects : . Tricyclic antidepressants . Tricyclic antidepressants . ANTIDEPRESSANTS AND MOOD DISORDER DRUGS Prototype : a. c. insomnia .

lethargy. lip smacking b. . . haloperidol (Haldol) Mechanism of action : .fentanyl (Sublimaze).thioridazine (Mellaril) b. Injection anesthetics . 6. diaphoresis.monitor white blood cell count (increase). and report to physician immediately. ketamine (Ketalar). hypothalamus. cardiovascular collapse b.isoflurane (Forane). fever.trifluoperazine (Stelazine). . Watch out of neutropenia with clozapine.hyperreflexia. 7.chlorpromazine (Thorazine). ANTIPSYCHOTIC DRUGS (NEUROLEPTICS) Prototype : a. Watch out for orthostatic hypotension and photosensitivity with phenothiazine. halothane . fine wormlike tongue movement c.5 mEq/L blood level may cause toxicity manifested by: confusion.maintain salt and adequate fluid intake . Avoid administering haloperidol intravenously 4.Extra pyramidal symptoms such as dystonia. Inhalation anesthetics . etomidate (Amidate) Mechanism of actions : ______________________________________________________________ .Neuroleptic malignant syndrome a. 2. and other regions of the brain. seizures.orthostatic hypotension Nursing considerations : 1. Other Agents .enflurane (Ethrane).clozapine (Clozaril). and an irreversible tardive dyskinesia as manifested by : a.6. .block dopamine receptor in the limbic system. Inform physician and withhold fluoxetine if client develop rashes. Phenothiazines . nitrous oxide b. muscle rigidity. pseudoparkinsonism. . thiopental Na (Penthotal). and not hoarded. Adverse effects : . 5. tachycardia.> 1.tremors may occur but it is temporary . Be sure that oral doses are swallowed. Take lithium with food to reduce GI effects . DRUGS USED IN PAIN MANAGEMENT General Anesthetics Prototype : a. 3. tachypnea. seizures. Teach family members the signs of EPS and NMS. Normalization of symptoms may not occur for several weeks after beginning of therapy . involuntary movements of arms and leg.

Non – narcotic analgesic NSAIDs – aspirin (aminosalicylic acid). unresponsiveness to pain stimuli. by producing loss of consciousness.relieves pain and fever by inhibiting the prostaglandin pathway. LOCAL AND TOPICAL ANESTHETIC Prototype : local : bupivacaine. ketoprofen (Orudis). Adverse effects : . . paracetamol and acetaminophen (Tylenol) Mechanism of actions : a. Narcotic analgesics .. butacaine. mepivacaine. dibucaine. Nursing considerations : 1.cause CNS depression. b. procaine.narcotic analgesic .observe for fetal bradycardia in pregnant clients. In patient who received halothane. 6.alter pain perception by binding to opiod receptors in CNS. butorphanol (Stadol) nalbuphine (Nubain) b. Avoid alcohol or CNS depressants for 24 hours after anesthesia.cardiac dysrhythmias Nursing considerations : . and muscle relaxation. Instruct client NPO for 8 hours before administration. Monitor urinary retention. Injury and accident precautions in clients taking narcotic analgesic. mefenamic acid (Ponstan). nausea. Narcotic analgesics . meperidine (Demerol) morphine. 2. prilocaine topical : benzocaine.administer cautiously to the areas of large broken skin.lignocaine + prilocaine (EMLA cream) should be applied topically 60 minutes before procedure. Nursing considerations : 1.jaundice and altered liver function. Monitor respiratory depression & hypotension in clients taking narcotic analgesic. tetracaine.block transmission of impulses across nerve cell membrane. vomiting .and do not discontinue narcotics ______________________________________________________________ . fever.lignocaine Mechanism of action : .rash. naproxen. 3.malignant hyperthermic crisis : dantrolene (antidote) 5. 2.codeine. Non. monitor signs of hepatic fatal side effects : . 4. ANALGESICS Prototype : a. ketorolac. Monitor cardio pulmonary depression and hypotension. Warn clients about possibility of dependency. Monitor body temperature . ibuprofen (Motrin). . 3. lidocaine.

normal PTT is 20-35 sec. Monitor hearing loss in clients taking aspirin. 7.best site). pulmonary embolism. 5. DRUGS AFFECTING THE CARDIOVASCULAR SYSTEM ANTICOAGULANTS Prototype : . Indications : .antidote : (protamine sulfate) 2. b. Naloxone is antidote for narcotic overdose. ______________________________________________________________ . Heparin . Warfarin . N-acetylcysteine is antidote for paracetamol overdose. 9. .thrombosis. HEPARIN sodium .5 times normal PTT. 6.warfarin is used for long-term . WARFARIN sodium (coumadin) .prevents thrombin from converting fibrinogen to fibrin. . = 50-85 sec. Aspirin is contraindicated in clients below 18 years old with flu-like symptoms.therapeutic level 1.bleeding Nursing considerations : 1.Heparin (SQ and IV) Warfarin (Orally) Mechanism of actions : a. 8.5-2. Monitor liver function in clients taking acetaminophen. myocardial infarction Adverse effect : . 4.abruptly in the narcotic-dependent clients.suppress coagulation by acting as an antagonist of vitamin K after 4-5 days.if given SQ don’t aspirate or rub the injection site (above the scapula . Advice clients to take NSAIDs with food and monitor bleeding complications.

normal PT = 9. .should be taken at the same time of the day to maintain at therapeutic level.onset of action is 4-5 days.use early in the course of MI (within 4-6 hours of the onset) Nursing considerations : . Urokinase Mechanism of actions : .8 sec.3 .9.10) I (PTT ) (PT) Vit K dep.HEMOSTASIS : Bleeding/injury I Vasoconstriction Plasminogen I I Platelet aggregation Plasmin ( temporary plug) I I I Clotting factor activation -------------I I I I Intrinsic pathway (8.therapeutic level is 1. = 25 .5 times normal PT.used in the prophylaxis of long-term complication following M.monitor bleeding .7.11. and thrombotic CVA.inhibit the aggregation of platelet thereby prolonging bleeding time. Ticlopidine Mechanism of action : .activates plasminogen to generates plasmin (enzyme that dissolve clots).antidote : Vitamin K ( Aquamephyton) THROMBOLYTICS Prototype : Streptokinase.antidote : Aminocarpic acid Antiplatelet Medications Prototype: aspirin.Fibrin split products (coagulation) ( Removed by liver & spleen ) . Dipyridamole (Persantin) Clopidoigrel (Plavix). INR = 2 . I I I I I Prothrombin activation I I I I Thrombin I I I Fibrinogen ------------Fibrin threads ------------. Indications : . .12) Extrinsic pathway (3. Indications : . coronary revascularization.6 -11.I.10. Nursing considerations : ______________________________________________________________ . .30 sec.reduce intake of green leafy vegetables.5-2.

isosorbide dinitrate (Isordil) . Indications : . if not relieved after 15 mins. Transdermal patch .note the BP before giving the medication.Monitor bleeding time ( NV = 1-9 mins) .protect the pills from light. Nitrostat) Mechanism of action : . .offer sips of water before giving because dryness may inhibit absorption.headache.digoxin (Lanoxin) and digitoxin (Crystodigin) Mechanism of actions : . orthostatic hypotension . ..remove the patch after 12-24 hours. anorexia.one tablet for pain and repeat every 5 mins. Sublingual medications : . . 2.increase intracellular calcium. allowing 10-12 hours “patch free” each day to prevent tolerance.Take the medication with food. atrial tachycardia and fibrillation Nursing considerations : . for a total of three doses. Indications : .nitroglycerine (Deponit.angina pectoris. ANTI-ARRHYTHMIC DRUGS Class I (block Na channels) ______________________________________________________________ .instruct patient not to swallow the pill .Should be caution in patient with hypothyroidism and hypokalemia.Phenytoin is the drug of choice to manage digitalis-induced arrhythmia. Adverse effects: . Nitrates Prototype : . halo vision. Nursing Considerations : 1..apply the patch to a hairless area using a new patch and different site each day. seek medical help. MI. producing positive inotropic & negative chronotropic action. peripheral arterial occlusive disease.Monitor for toxicity as evidence by : nausea.produce vasodilatation including coronary artery.use for CHF. bradycardia and heart blocks .stinging or burning sensation indicates that the tablet is fresh. . which causes the heart muscle fibers to contract more efficiently. . vomiting.sustained release medications should be swallowed and not to be crush.Antidote : Digi-bind . CARDIAC GLYCOSIDES Prototype: . . confusion. . .Do not administer if pulse is less than 60 bpm. .

prevent peripheral vasoconstriction by blocking conversion of angiotensin I to angiotensin II decreasing peripheral resistance. CALCIUM-CHANNEL BLOCKERS Prototype : .it cause hyperkalemia .flecainamide Class II (Beta-blockers) propanolol.prevent constipation. Watch out for signs of CHF. Nursing considerations : .avoid using K+ sparing diuretics. Have client weigh themselves and report weight gain. Adverse effect : . procainamide IB .lidocaine IC . colestipol. clofibrate Mechanism of actions : . enalapril (Vasotec). diltiazem Nursing considerations : 1. cholelithiasis .gemfibrozil. triglyceride-lowering agents . Felodipine (Plendil) Verapramil (Isoptin) Mechanism of action : .IA . lovastatin b. thus decreasing the ______________________________________________________________ . 2.confusion and restlessness ANTILIPEMICS Prototype : a. cholesterol-lowering agents .Nifedipine (calcibloc.induce chronic cough Nursing considerations : . adalat). ANTI – HYPERTENSIVE Angiotensin-Converting Enzyme (ACE) Inhibitors Prototype : captopril (Capoten). .encourage increase fluid and fiber intake. 3. Amlodipine (norvasc). bretylium Class IV (block Ca channels) verapramil.cholestyramine. flatulence.quinidine. Watch out for signs of lidocaine toxicity : . esmolol Class III (block K channels) amiodarone.interfere with cholesterol synthesis as well as decreasing lipoprotein & triglyceride synthesis. .decrease cardiac contractility and the workload of the heart.monitor liver functions while using statins. lisinopril Mechanism of actions : .not to discontinue medications because it can cause rebound hypertension. quinapril.

Take client’s pulse rate before each dose.Administer between meals to enhance absorption. dilate airways.usually given at morning CARBONIC ANHYDRASE INHIBITORS .hyperkalemia RESPIRATORY MEDICATIONS Bronchodilators Prototype : Symphatomimetic Xanthines .blocks Na.aminophylline . K+. arrhythmia Adverse effects : . ______________________________________________________________ .Mannitol .Spironolactone (Aldactone) . hypotension.it also promote vasodilatation of the coronary and peripheral vessels. Indications : .hypertension.hypotension THIAZIDE DIURETICS . reabsorb Ca . withhold if pulse is below 60 bpm. salbutamol .isoproterenol. . angina. stimulate CNS for respiration.metabolic acidosis OSMOTIC DIURETIC . salmeterol .reflex tachycardia. constipation Nursing considerations : . headache . DIURETICS . . . K.Acetazolimide (Diamox) .hydrochlorothiazide . along with it is H2O .albuterol.hypocalcemia POTASSIUM SPARING DIURETICS .hypercalcemia LOOP DIURETICS .Refer for signs of congestive heart failure.blocks Na and K reabsorption.Increase osmotic pressure of the glomerular filtrate. .terbutaline Mechanism of actions: . and Ca reabsorption .sympathomimetic (b-receptor agonist) bronchodilators.Furosemide (Lasix) . & HCO3 secretion.increase Na+. .excrete Na and water but it reabsorb K .theophylline .need for O2.bradycardia.xanthine bronchodilators.

. GLUCOCORTICOIDS (CORTICOSTEROIDS) Prototype : .Instruct client not to stop medication abruptly. Nursing Consideration: .restlessness.act as anti-inflammatory agents and reduce edema of the airways. low in sodium. as well as pulmonary edema. bronchitis.Indications : .anorexia. .Should be given before asthmatic attacks.Drink a few sips of water before & after inhalation to prevent cough & unpleasant taste . neutropenia.bronchospasm. COPD. Mechanism of actions : . MAST CELL STABILIZERS Prototype : cromolyn sodium (Intal) Mechanism of action : . Adverse effects : . nausea and vomiting. . osteoporosis Nursing considerations : .Cushing’s syndrome. headache. nervousness.dexamethasone.Eat foods high in potassium. fluticasone. or uncontrolled seizure disorder. . ______________________________________________________________ .Instruct client to avoid individuals with RTI.Astemizole (Hismanal).palpitations and tachycardia . .Should be used with caution in patient with HPN and narrow-angle glaucoma. Nursing considerations : . cardiac dysrhythmia. budesonide. and rinse mouth after using.Take drugs at meal time or with food.stabilize mast cells that release histamine triggering asthmatic attacks. . prednisone. dizziness. it should be tapered to prevent adrenal insufficiency . beclomethasone. Loratidine (Claritin).Contraindicated hyperthyroidism. ANTI-HISTAMINES (H-1 BLOCKERS) Protoytype : .Take inhaled bronchodilators first before taking inhaled steroids.Assess for lactose-intolerance. Adverse effects : .Administer oral capsule at least 30 mins before meals for better absorption. asthma. tremors .Avoid taking NSAID while taking steroids. .

increase serum uric acid and cause photosensitivity.hepatotoxic thus avoid alcohol.Given IM via Z-track method or orally. .administer with Vitamin B6 to counteract the neurotoxic side effects.should be given at least 1 hr before antacids. Celestamine (Tavist).Precautions in handling machine and driving while taking these drugs. Diphenhydramine (Benadryl).given for 2 months.Rifampicin (Rifadin) . Nursing Considerations : .Ice chips or candy for dry mouth ANTI-TUBERCULOSIS Prototype : First line . .should be given 1 hr before or 2 hrs after meals because food may delay absorption. .avoid alcohol.Para-aminosalicylic acid . Pyrazinamide . .active tuberculosis are treated with drug combination for 6-9 mos. . urticaria. nausea and vomiting. Indications : . Cetirizine (Iterax). .Isoniazid (INH) .Pyrazinamide . 1 hour before or 2 hours after meals and avoid taking antacids with medications. Rifampicin . .Kanamycin . and tears will be redorange in color.Streptomycin Second line .Brompheniramine (Dimetapp). sweat.given on an empty stomach with 8 0z.Cycloserine . of water.Ethambutol . allergies and as sleep aid. rhinitis. Mechanism of action : .multidrug-resistant strain (MDR-TB) are medicated for 1 year up to 2 years .given before meals Isoniazid .Ethonamide .Administer with food and drink.common colds.decrease nasopharyngeal secretions and decrease nasal itching by blocking histamine in H1-receptor. . . ______________________________________________________________ . . feces.instruct the client that urine. .instruct to notify physician for signs of hepatoxicity (jaundice). and neurotoxicity numbness of extremities.

electrolyte imbalance . ______________________________________________________________ .sodium bicarbonate (Alka-Seltzer) . pantoprazole (Pantoloc). DRUGS AFFECTING GASTROINTESTINAL SYSTEM Antacids Prototype : . .toform hydrochloric acid. stone formation .inhibit the proton H+ to combine with Cl. . reducing acid secretions. Proton – Pump Inhibitors (PPI) Prototype : .Ethambutol . .obtain a baseline visual acuity because it can cause optic neuritis.cimetidine (Tagamet). .Given before or with meals .metabolic alkalosis. constipation (aluminum). Mechanism of actions : . Mechanism of action: . nizatidine (Axid). Lansoprazole (Lanz).obtain baseline audiometric test and repeat every 1-2 months because the medications impairs the CN VIII. .Instruct the client to notify the physician immediately if any visual problems occurs. Nursing considerations : . HISTAMINE – 2 BLOCKERS Prototype : . Nursing considerations : .diarrhea (magnesium).Avoid giving medications within 1-2 hrs of antacid administration (decreases absorption). .aminoglycoside antibiotic given IM.omeprazole (Losec). Mechanism of action : .aluminum/magnesium compounds (Maalox) .Take fluids to flush after intake of antacid suspensions. . Streptomycin .calcium carbonate (Tums) .Give 1 hr after meals.Avoid giving other drugs with cimetidine . famotidine (Pepcid).magnesium hydroxide (Milk of Magnesia).nephrotoxic and ototoxic.Gynecomastia may developed with chronic use of cimetidine.neutralize the stomach acidity.contraindicated in children under 13 years old. Adverse effects : .Monitor for changes of bowel patterns.blocks H2 receptors in the stomach. ranitidine (Zantac).

Nursing considerations : .Consult poison control center before induction of vomiting. white or pale stool is common with kaopectate.Administer ipecac syrup with large amount of fluid.Monitor atropine toxicity with diphenoxylate. . Nursing considerations : . kaolin/pectin mixture (Kaopectate). loperamide (Imodium). mineral oil .Sucralfate cause constipation.irritates intestinal mucosa and stimulate intestinal smooth muscles d.lubricates & prevent colon absorption EMETICS Prototype : ipecac syrup.Given before meals.ingestion of poisonous or toxic substances.Clay.diphenoxylate (Lomotil).increase fecal bulk and water content e. Na biphosphate (Fleet enema) & magnesium salt (Milk of Magnesia) .Given before meals preferably at morning.retain fluid and distend intestine b.Misoprostol is contraindicated for pregnants. Laxatives a. . Nursing consideration : . apomorphine Mechanism of actions : . ducosate (Dialose) . Anti-diarrheal Agents Prototype : . .decrease stomach motility and peristalsis. bisacodyl (Dulcolax) & senna (X-prep) .Monitor for rebound constipation. Mucosal Barriers Prototype : . Mechanism of actions : .induce vomiting through stimulation of vomiting center of medulla.emulsify fecal fat and water c. Mechanism of action : . . Indications : . . . bulk-forming laxative (Metamucil) . misoprostol (Cytotec).Nursing considerations : .Be cautious taking if with infectious diarrhea.sucralfate (Carafate). DRUGS AFFECTING THE ENDOCRINE SYSTEM THYROID AGENTS ______________________________________________________________ .coats the mucosa to prevent ulcerations. lactulose (Cephulac).

.Report for bone pains. reduce bone resorption b. .function as natural or synthetic hormones.Taken in the morning.Monitor signs of calcium imbalance . Sulfonylureas . First Generation : Chlorpropamide (Diabenese) . etidronate (Didronel).stimulate insulin secretions and increase tissue sensitivity to insulin. Mechanism of action : . Nursing considerations : .Monitor for signs of hyperthyroidism and refer for decreasing the dose.Synthroid (levothyroxine) . calcitonin (Calcimar).congenital defect Second Generation : Glypizide.Remain sitting upright after taking etidronate. Glymepiride 2. PARATHYROID AGENTS Prototype : a.Proloid (thryroglobulin ) .side effect is lactic acidosis 3. b. Biguanides .Cytomel ( liothyronine). . promotes calcium absorption Nursing considerations : . Alpha-glucosidase inhibitors ______________________________________________________________ .disulfiram precautions Tolbutamide (Orinase) . Oral Hypoglycemic Agents (OHA) 1. calcitrol (Rocaltrol). calcifediol (Calcedrol) Mechanism of action : a.Prototype : .facilitates insulin action on the peripheral receptor site.Caution with coronary artery disease. Metformin and Glucophage (Glucovance) .

Rosiglitazone (Avandia) 5.stimulate insulin release in pancreatic B-cells.Alcohol is recommended for cleansing bottle but not with skin.Prefilled syringes are stored vertically.Monitor for acute hypoglycemia : a. .5–1h 5 h (lispro) Short-acting 0.M. Glucagon 1 gm SQ or IM e. 4-6 ounce of fruit juice or regular soda c.15h 0.Used bottles stored in room temperature.Usually given before meals. . . Meglitinides . .Pinch skin. . Insulin Insulin Onset Peak Duration Immediate-acting 0. D50-50 IV.delay carbohydrate absorption in the intestinal system.5 h 4-8 h 25 h (regular 30%. .5-1 h 2-4 h 5-7h (regular. Repaglinide (Prandin) Nursing considerations : . don’t shake.Contraindicated to pregnant & breastfeeding.Monitor for signs of hypoglycemia. . lente) Long-acting 4-6h 10-30 h 24-36 h (ultralente) Mixed 0. unused bottle stored in refrigerator. . needle-up. 3-4 commercially prepared glucose tablet b. ESTROGENS AND PROGESTINS Prototype : ______________________________________________________________ . avoid I.Given before meals. Acarbose (Precose) – side effect is diarrhea 4. Thiazolinidine .increase tissue sensitivity of insulin.Inject amount of air that is equal to each dose into the bottle – short acting last (clear). . 2-3 teaspoon or honey d. . NPH 70%) Nursing considerations : . don’t aspirate.Aspirate short acting first. . . ..Effective only for type II DM.Rotate the injection site an inch a part.Roll the bottle in palm of hands. semilente) Intermediate-acting 1-3 h 6-12 h 18-24 h (NPH.May increase dose during illnesses. then long or intermediate (cloudy).

tremors. Teach patient how to perform BSE. terbutaline (Brethine) Mechanism of actions : .estrogen replacement Adverse effects : estrogen .prostate cancer.hypertension (ergonovine). methylergonovine (methergine) b. gallbladder disease. estradiol (Estrace). dinoprostone (Prostin E2) Mechanism of actions : a.endometrial CA. Indications : . migraine. carbopost (Prostin).altered menstrual flow. 4.allergic reactions (Prostaglandins) Uterine Inhibiting Agents (Tocolytic) Prototype : .. vomiting and tachycardia ______________________________________________________________ . Monitor blood pressure 3. Mix estrogen or progestins prior to IM administration by rolling vials between palms. Regular follow-up examination is required to detect associated risk of acquiring CA DRUGS AFFECTING LABOR and LACTATION Uterine Stimulating Agents Protoytpe : a. 2.relaxes the uterus by stimulating the B2.fetal bradycardia (oxytocin). breast tenderness progesterone . diethylstilbestrol (DES). estrone (Bestrone). Oxytocin (Pitocin).adrenergic receptors Adverse effects : . nausea. ergonovine (Ergotrate).conjugated estrogen (Premarin). ripening of cervix Adverse reactions : . stimulates uterine smooth muscles b.ritodrine (Yutopar). contraceptions . . palpitations . HPN. risk of thrombo embolism Nursing considerations : 1.

4. glycopeptide .Gray syndrome.granulocytopenia.Steven-Johnson’s syndrome. 3. Antiviral Agents Prototype : . gentamycin b.acyclovir (Zovirax).ciprofloxacin.drowsiness. penicillins . 5. Protein synthesis inhibitors a. thrombocytopenia.cotrimoxazole 4. cefaclor c. Sulfonamides . nausea. amoxicillin. Monitor adverse effects. Erythromycin . Quinolones . cloxacillin b. nausea.cephalexin.amikacin. Tetracyclines .decrease serum prolactin levels Adverse effects : . cephalosphorins . ribavirin (Virazole).clindamycins d. Check client’s history of allergies. macrolide . nephrotoxicity. They only control the growth of virus but it does not cure.bromocriptine (Parlodel) Mechanism of action : . headache. tetracyclines 3. Cell wall inhibitors a. Mechanism of actions : . Report for diarrhea . Pregnant precautions. bone marrow depression 6. Aminoglycoside .vancomycin 2.hepatitis Nursing considerations : 1. lincosamides . DNA synthesis inhibitors a. roxithromycin c. amantidine (Symmetrel).erythromycins.pen G.insomnia 4. aminoglycosides . Avoid administering erythromycin and quinolones with food. headache. ______________________________________________________________ .blocks folic acid synthesis a. Antimetabolites .bone problems 5. vidarabine (Vira-A).Lactation Suppressants Prototype : . metronidazole Adverse effects : 1. chloramphenicol. Chloramphenicol . Collect appropriate specimen for C & S before starting antibiotics. ofloxacin b. 2. photosynsetivity 3. quinolones .nephrotoxicity & ototoxicity 2. zidovidine (Retrovir).inhibits virus specific enzymes involve in DNA synthesis. nervousness. palpitations DRUGS FOR TREATING INFECTION Antibacterial Agents 1. Adverse effects : . ganciclovir (Cytovene).pseudomembranous colitis (clindamycin) 6. Sulfonamides .

and visual changes. fluconazole (Diflucan).Administer IV antivirals to avoid crystallization in renal tubules.Refer for signs of bleeding.chlroquine. nystatin.Take amantidine after meals. 3. depleting folates. abdominal pain and headache. .With oral candidiasis. furozolidone (Furoxone).chills. ketoconazole (Nizoral). iodoquinol.Pregnant and breastfeeding precautions.bone marrow depression .Report for signs of bleeding. .Dilute amphotericin B with sterile water solution not with electrolyte solution. primaquine. joint and muscle pain will subside as amphotericin B continues. . . Antimalarial .tinnitus. Take seizure precautions while administering antimalarial drugs.Monitor CBC and creatinine level. Mechanism of actions : . GI upset. 2.nephrotoxicity and neurotoxicity . ______________________________________________________________ . . antimalarial – alters protozoal DNA. Nursing considerations : 1. vertigo. pyrimethamine b. chills. Inform clients that iodoquinol falsify thyroid function test for up to 6 months. Antiamebiasis . let nystatin tablet dissolve in mouth rather than swallowing it.amphotericin B (Fungisone). fever. antiamoeba – block protein synthesis. Antifungal Agents Prototype : . Administer anti-malarial drugs with food.metronidazole (Flagyl). . infection & fatigue. Adverse effects : . . Nursing considerations : . . 4. Mechanism of actions : a.Give ribavirin only with aerosol generator. Refer cinchonism during quinine treatment: . ANTIPARASITIC AGENTS Prototype : a.Refrain ketoconazole with antacids. & reducing nucleic acid production b. headache. fever.Nursing consideration : . quinine. mefloquine. joint pains.inhibit the synthesis of fungal sterol. .Tell clients that fever.

praziquantel (Biltricide). .inhibits cell production by causing cross linking of DNA a. Mechanism of actions : . .given with leucoverin to lessen its toxicity.ANTIHELMINTIC Prototype : . Chlorambucil – gonadal suppression c. 3.mebendazole (Vermox). 4. urinary odor (thiabendazole) .GI upset.preferably given through IV route. ANTI-NEOPLASTIC DRUGS General considerations : . Hormonal Medications and Enzymes ______________________________________________________________ . Treat all the family members for nematodes infection to prevent recurrence. Cisplatin – ototoxicity and nephrotoxicity d. Antimetabolites . thiabendazole. Cytarabine – hepatotoxicity b. Other antihelmintics should be chewed. Antitumor Antibiotic Agents . Adverse effects : .it could be cell cycle phase specific or cell cycle non-specific. 2. Plicamycin – affects bleeding time b. 2. niclosamide (Niclocide). numbness 5. Prototype : 1. Alkylating Agents . 6-marcaptopurine – hyperuricemia d. Mitotic Inhibitors (Vinca Alkaloids) . Cyclophosphamide – hemorrhagic cystitis. Praziquantel must swallowed rapidly because of its bitter taste to avoid gagging.headache. fatigue Nursing considerations : 1.paralyze larva and adult helmints by acting on parasite microtubules.replace normal proteins required for DNA synthesis by inhibiting the S phase a.prevent mitosis acting on the M phase causing cell death a.kills or inhibit the reproduction of neoplasmic cells but as well as normal cells.interfere in DNA and RNA synthesis a. dizziness. Methotrexate – photosensitivity . Vincristine sulfate – neurotoxicity. Doxurubicin – cardiotoxicity c. Busulfan – hyperuricemia b. 5-flourouracil – phototoxicity reaction and cerebellar dysfunctions c. 3. piperazine (Antepar). Bleomycin – pulmonary toxicity.

Tamoxifen citrate – visual problems – elevate cholesterol & triglycerides level b..reverse isolation . that is why you must not take too many of the pills” b.reassure that menstruation will resume. “You will be needing only three tablets to ease the pain and if unrelieved. The physician orders for nitroglycerin tablet.anti-emetic.low bacteria diet anemia .hyperuricemia & hyperkalemia .notify physician if WBC is <2000/mm3 .bland diet.use soft toothbrush and electric razor menstrual changes . A diagnosis of CAD with angina pectoris was established 1. nausea and vomiting .” At this instance.provide rest periods bleeding . Diethylstilbestrol – impotence and gynecomastia in men. replace fluids and electrolytes alopecia . Hero Fernando. To dissolve the atheromatous plaque in the coronary artery b. you must seek medical attention” ______________________________________________________________ . Decrease the myocardial consumption of oxygen 2. avoid strong mouthwash .force fluids infection . hats and head scarf skin pigmentation . folic acid rich food .reassure that it is temporary . “I agree. Side Effects: stomatitis . THE END REVIEW QUESTIONS SITUATION: Mr. chest pain. He remarked.inform that it is only temporary tumor lysis syndrome . The nurse knows that the pharmacological action of the drug is: a.avoid NSAIDs . a 60 year-old bank manager had experienced a sensation of chest tightness.soft tooth brush. B-12.encourage o wear wigs.monitor for signs of infection . ice chips diarrhea. Constrict the venous vessels and capillaries c.minimize invasive procedures . “I think I will try not to take too many of these pills. “I must inform you that nitroglycerin is non-habituating and you should take the pills many times to relieve the pain” c. Dilate the coronary arteries d. nitroglycerin can cause drug addiction. the nurse’s BEST reply would be: a.iron. sweating and a feeling of apprehension.block the normal hormones in hormone sensitive tumors a. The nurse gave instructions to the patient on nitroglycerin intake.

He had hypertensive emergency 2 hours ago and was hospitalized for further observation. The nurse understands that her discharge teaching is effective regarding life style modification when the patient says: a. The nurse best suggests: a. The nurse chooses a hairless area b. Hero asked the nurse what he could do about his concern about sex activity. the nurse must caution the patient: a. “I need to enroll in a gym class to have a vigorous exercise to condition my heart” SITUATION: Manny is admitted to the medical ward with the diagnosis of essential hypertension. Metoprolol c. To avoid straining during defecation b. The nurse applies the ordered nitroglycerin ointment on the patient’s chest wall. To take warm shower immediately after taking the drug ______________________________________________________________ . 9. Keep the tablet in a clear container b. “I know that I will need to eat less. Only take the nitroglycerin as desired b. “ There is no problem with continuous daily intake because nitroglycerin does not cause a tolerance effect” 3. Tell him to avoid sex on days when he is anxious d. Headache c. “I will stop what I’m doing whenever I have pain and take the pill” d. Continue to take as many tablets of nitroglycerin until chest pain subsides d. She spreads the ointment with her fingers c. she will check the pulse prior to giving: a.d. She removes the ointment on the skin from the previous dose d. Nifedipine b. If it can be any of the following. To avoid low-sodium and potassium diet c. Clonidine d. She rotates the sites of ointment application 6. increase the frequency of the dose 7. Take the tablet with meals c. The nurse must emphasize to the patient which ONE of the following sideeffects of nitroglycerin: a. Visual changes 4. Which nursing action is considered inappropriate? a. Captopril 10. The drug should be taken before engaging in exertional activities c. so I will eat once a day only” b. What other information must the nurse provide to the patient taking the nitroglycerin? a. Nausea and vomiting b. Suggests that his wife assume the top position c. The nurse administers prescribed anti-hypertensive meds. The tablet should be taken only in the morning d. A burning sensation under the tongue is expected 5. Advise that he should have sex only once a month 8. The nurse gives which of the following discharge instructions to this patient with angina regarding nitroglycerin therapy? a. To avoid abrupt change of positions d. Hypertension d. “I will stay on bed most of the time so I wont experience chest pain” c. If the drug does not relieve the pain. Tell him to avoid sex for several months while his heart is on therapy b. After administering a blood-pressure lowing agent.

o. Take the central venous pressure reading b. The mechanism of action of dioxin that makes it useful in patients with CHF is that it: a. Verapamil c. the nurse must caution that the side-effect of this drug that is disturbing is: a. with the exception of: a. Decreased bowel sounds b. Increased drowsiness d. Businessman awakens in the middle of the night with dyspnea. Ringing of the ears 13. Which one statement below by the patient may alert the nurse of a possible development of toxicity? a. Telmisartan d. Canned meat loaf b. Increased urine output c. Pruritus d. Observe for signs and symptoms of hypokalemia d. If the physician orders Captopril as the home medication for the high BP. Increases cardiac conduction c. The nurse prepares to give a diet appropriate for a hypertensive patient. Diplopia and visual yellow-green halos d. Enhances cardiac contractility d. Perform active exercises to prevent Hypotension d. If the client is discharged with home medication of Propranolol hydrochloride. bilateral basilar rales and frothy sputum. Diltiazem SITUATION: Joseph. Take the medication on an empty stomach b. His diagnosis is congestive heart failure. Cough c. 50 y. Force fluids 16. Rashes b. 15. The following manifestations must be assessed by the nurse to detect beginning digitalis toxicity. Caution to avoid hazardous activities after taking the drug 14. The nurse is very vigilant about digoxin overdose. “I am having constipation lately” c. Obtain blood pressure readings regularly c. “I am experiencing dryness of the eyes and sandy sensation” 18. The nurse evaluates that the drug digoxin is effective when the patient manifests: a. “I am developing a nagging cough and night terrors” d. “Nurse. Scallops and shrimps c.. Which food should the nurse include in the menu? a. I don’t feel like eating for the past few days” b. Produces a negative inotropic effect b. Nausea and vomiting b. The physician gives the patient furosemide and digoxin. Increases the heart rate 17. The nurse determines that the following drugs are calcium channel blockers that can be prescribed by the physician to the patient. Hypertension ______________________________________________________________ . One is not included: a. the nurse must include in her medication-teaching plan which one? a. Nifedipine b. He is brought to the Mulawin hospital. Butter and pork steaks 12. Fresh citrus juice and cake d. Decreased sympathetic response of the body 19. Palpitations c. The nurse’s main concern is to: a. Observe for decrease edema c.11.

The nurse obtains an apical pulse of 78 beats/min. Instruct patient to consume more meat and nuts d. except: a. Bone marrow aspiration b. Intravenously. Antihistaminic 24. Yellowish discoloration of the skin and mucus membrane b. Dried mangoes and tomato juice c. A drug is administered to correct anemia. Presence of excessive iron in the liver c. Flavored gelatin and iced tea 21. The doctor decides to order Iron dextran one ampoule. Z-track method c. She will give the medication: a. This drug is classified as: a. it was determined that she has pernicious anemia. She is certain that her teaching is effective when the patient will choose all the foods items below. Lean meat and buttered corn d. With antacids to minimize gastric upset c. Gelatin and marshmallows c. The health center physician determines that she has iron-deficiency anemia. Temporary bone marrow depression. The nurse instructs the patient to eat iron-rich foods. Broccoli salad with bean sprouts d. Anorexia and loss of hair d. Darkening of stool color c. Anticoagulant c. Start IV infusion of Digibind (digoxin antibody) c. The nurse administers the oral iron tablet. Administer the drug SITUATION: Armida. Fresh orange juice and potato fries b. Intrathecal 27. BUN and Creatinine 23. She determines that her teaching is effective when the client will choose: a. Hematinic d. She is bringing the next dose of digoxin and then proceeds to do which one action below? a. Subcutaneous d. The nurse prepares to administer the drug: a. Withhold the drug and notify the physician b. With a full glass of coffee or tea 25.20. upon further examination. With fruit juices like calamansi and orange d. The nurse must warn the patient taking oral iron preparations that it can cause which side effect/s? a. The nurse will anticipate the doctor to order for: a. The pathophysiology of this hematological disorder is: a. an 18-year-old adolescent is seen in the health center because of easy fatigability and frequent dizziness 22. Absence of Vitamin E in the diet b. Slow IV push b. Hemoglobin level determination c. Liver and eggyolk 26. With milk and dairy products b. Antihelminthic b. The patient remained pale and weak. Pomelo juice and hamburger b. Ulceration of the skin and cough 28. Absence of intrinsic factor in the stomach d. such as an iron. Intamuscular. Platelet count d. The nurse instructs the patient on diet modification during digitalis therapy. DRUGS THAT AFFECT THE HEMATOLOGICAL SYSTEM ______________________________________________________________ .

2 times the normal c. the nurse must obtain which laboratory tests from the lab unit? a. Ecchymoses b. she is observing for the following signs/symptoms. Thrombocytopenia b. The clot formed in the vein must be lysed by activating plasmin. Amor? a. Ice compress over the involved leg TID b. IV and IM b. Maintain on strict bed rest with minimal bathroom privileges d. The LMWH can be administered IM b. the action of heparin 31. the nurse prepares which one antidote for toxicity? a. In the event of an overdose of heparin injection. Prothrombin consumption test 32. Prothrombin time b. There is a need to prevent further clot formation in the involved vessels c. Elevate the legs with a pillow c. Less than the normal 33. ID and IM d. Heparin will dissolve the clots in the inflamed veins to prevent emobolization b. The LMWH does not need frequent laboratory monitoring c. Epistaxis 35. Equals the normal d. If the doctor orders for heparin therapy monitoring.SITUATION: Mrs. Partial thromboplastin time d. Deferoxamine chelators 37. 29. The doctor switched from standard heparin to low molecular weight heparin injection. Clotting time c. Rosalinda Amor. Atropine Sulfate c. The advantage of LMWH over the standard heparin is: a. except? a. 23 year-old actress is admitted because of a diagnosis of deep vein thrombosis. The physician orders Heparin sodium for Mrs. Constipation c. IV and intrathecal 34. The nurse must administer heparin to Mrs. cola-colored urine d. Dark. Which one effect of heparin therapy will cause nursing concern? a. The above laboratory value must is considered therapeutic if the result is about: a. Heparin will anticoauglate the blood by inhibiting vitamin K metabolism d. Phytomenadione b. The LMWH has a better potency d. She determines that the most common routes of administration are: a. The nurse understands the reason for this therapy is that: a. When the nurse is monitoring the patient for heparin overdose. Massage the involved area 30. The nurse employs which of the following non-pharmacological measures in caring for Mrs. Positive Homan’s sign c. Bone marrow depression d. SC and IV c. Dizziness 36. The LMWH does not cause bleeding problems ______________________________________________________________ . Protamine sulfate d. Amor. 3 times the normal b. Amor.

Utilize firm toothbrush when brushing to prevent build up of plaques and gingival hyperplasia 40. Mrs. On an empty stomach to increase absorption b. Dipyridamole c. Congestive heart failure c. Withhold the heparin and administer the Warfarin orally d. Report the error to the nurse supervisor as the patient may be at risk for toxicity 39. The reason aspirin is utilized as an anti-platelet medication is because: a. Aspirin affects the thromboxane production of the platelet c. Administer the drug as ordered c. If the above drug is ordered to be given IV drip. Have heparin sodium available b. Observe for psychotic symptoms d. Monitor closely the renal status c. The nurse will: a. 41. and this may be: a. Avery had a previous attack of mild stroke and coronary artery disease. the nurse must make which one priority intervention? a. The doctor ordered Lovastatin OD. Avery had a sudden severe and prolonged chest pain. IF Mrs. With meals c. 46. Intramuscularly 43. Further damage to the myocardium d. The nurse determines that the BEST time to give the drug is: ______________________________________________________________ . the nurse must include in her discharge teaching which one? a. The nurse must remind the patient that warfarin therapy is monitored with the use of which laboratory examinations? a. the nurse must be aware of which potential effect? a. Question the order because of potential excessive bleeding if given simultaneously b. Tranexamic Acid b. Take aspirin to manage the headache side-effect of the drug d. Excessive clot formation 45. Clotting time and bleeding time d. Aspirin interferes with the receptor binding of the platelets d. If the patient is receiving tissue-plasminogen activator. Amor is discharge with warfarin sodium. The nurse reads the chart and notes for an order of oral Warfarin sodium.38. Keep Vitamin A ampule available for injection c/o the health center in case of emergency b. Report any bright red blood in the stool or urine c. The nurse administers aspirin: a. Coumadin 44. In Between meals d. Aspirin can prolong the bleeding time b. while the patient is on heparin therapy. PT and PTT b. Hypersensitivity reaction b. The nurse anticipates the doctor to order a fibrinolytic. Platelet count and PT SITUATION: Mrs. PT and INR c. Obtain a stand by Aminocaproic acid SITUATION: A patient is determined to have hypercholesterolemia and is admitted in the hospital for treatment of her condition. She is taking Aspirin. Acute MI is suspected. Steptokinase d. Aspirin blocks the degranulation process inhibiting release of histamine 42.

Nausea and vomiting are potential problems alleviated by small frequent meals d. flatulence and diarrhea b. Coffee and chocolate c. Gemfibrozil c. the nurse should check Blood pressure and CVP readings Urinary output per hour Breath sounds Level of consciousness Pupillary reflexes 53. She includes in her teaching which of the following interventions? a. Hypertension and rashes 49. Suggest to buy a nebulizer machine to be used at home e. At bedtime d. The nurse is giving Guaifenesin to a patient. It promotes cholesterol metabolism in the adipose tissue to lower the plasma cholestero 48. Sugar and cream b. It Inhibits the formation of chylomicrons in the intestinal cells b. To be for: a. Spinach and broccoli d. In the morning before breakfast to promote absorption b. Coffee and chocolate c. The nurse is knowledgeable about the mode of action of lovastatin that it: a. Canned goods and wine 54. Sugar and cream b. Vitamin ADEK supplements because of impaired absorption 52. It binds with bile acids and cholesterol promoting excretion d. She monitors the patient for: a.a. Cataract c. In between meals 47. Glaucoma b. Abdominal fullness. Palpitations and arrhythmias d. b. The nurse cautions the patient to avoid foods with components similar to theophyline and they can be: a. Beans and aged cheese e. The nurse must monitor for these serious adverse effects of lovastatin. d. It prevents the enzyme that synthesizes cholesterol c. able to detect the effectiveness of Salbutamol. In the afternoon to promote sleep because it is sedating c. Spinach and broccoli ______________________________________________________________ . Myositis d. Hepatic failure 50. c. Vitamin supplements d. Paracetamol b. The patient is receiving theophylline capsule OD. The nurse cautions the patient to avoid foods with components similar to theophyline and they can be: a. The patient is receiving theophylline capsule OD. Confusion and psychoses c. Warn the patient that extreme drowsiness may occur b. Which one is not included? a. The nurse is prepared to provide comfort measure to the common side effects of the drug. Offer a full glass of water c. e. Omeprazole 51. The nurse reads the drug order sheet and is most concern to consult the physician if he orders: a.

administer lidocaine d. Rheumatoid arthritis c. It is very much important to keep which item below at bedside? a. Salbutamol 61.give the drug in the morning e. Instruct the patient to clear the nasal passage of mucus before instilling b. Manage gastric upset by taking it with food 57.provide liberal fluids b. Take sugarless candy in the mouth to relieve dryness c.d. Triggering the vagal responses ______________________________________________________________ . Polycystic ovarian disease e. Hypothyroidism b. the nurse must ensure that the patient understands the teachings below. Ambu bag c. The nurse understands that this drug acts to suppress cough by: a. EXCEPT: a. The nurse is administering acetylcysteine nebulization to a patient. Ipratropium bromide e. Tachypnea. Increasing the secretions of the bronchial glands b. Terbutaline c. The physician orders dextromethorphan for a patient who is complaining of very uncomfortable coughing. The nurse obtains from the pharmacy which drug? a. The nurse is administering oxymetazoline nasal decongestant. After giving diphenhydramine to the patient. EXCEPT? a. Removing the irritation from the respiratory tract c.position on semi-fowler’s 58. Check pulse rate before taking the drug e. Inhibiting the medulla oblongata cough center d. Terbutaline sulfate is administered to a patient with asthma. Polyuria. Canned goods and wine 55. NG tube 56. The nurse watches out for a side-effect associated with intake of codeine sulfate and provides appropriate intervention. Remind patient to keep the head tilted for a few seconds after administration c. Inhibiting the stretch receptors in the lungs e. this can be: a. The physician asks the nurse for an anticholinergic drug to be used for the asthmatic patient. Encourage the use for one week for better effect e.provide less stimulation c. Tachycardia. Suction machine d. If the patient has another disease. Constipation. Beans and aged cheese e. Caution that tachycardia and urinary retention may occur with systemic absorption 60. Refrain from manipulating delicate machines b. the nurse is most vigilant and cautious if this condition exists: a. She includes in her care plan all of the following interventions. Tracheostmy set e. Excitement. Metaproterenol d. Advise increased fluid intake d. Emphysema 59. Albuterol b. Avoid taking the drug with alcohol d. Diabetes mellitus d. Scissors b.

Have less sedation and anticholinergic properties c. Promotes the secretion of mucus c. Tachycardia d. Drowsiness e. Highly effective in terminating acute asthma attack e. May depress the immune function d. Have shorter duration of action that can be reversed rapidly b. Dizziness 65. Acts rapidly to decrease inflammation b. Headache ______________________________________________________________ . Pallor e. Urinary frequency d. Posses less drug sensitivity reactions d. Have less abuse potential 64. Dry mouth b. The second generation anti-histamines like cetirizine have the advantage over the first generation antihistamines like diphenhydramine because second generation antihistamines: a. Inhaled corticosteroid like beclomethasone is administered to the patient with asthma. Increased alertness b. Severe hypotension c.62. Have a greater safety profile e. if given rapidly can cause: a. Blurred vision c. The nurse cautions the patient taking diphenhydramine (Benadryl) to expect all of the following side effects. The nurse must remember to administer theophylline slowly or with an infusion pump because this drug. It is important for the nurse to stress that this drug: a. except? a. Is habituating and addicting 63.

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