Pharmacology: Medications and Contraindications

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Questions and Answers

A client asks if their prescribed gentamycin medication can be crushed. Which response should the nurse provide?

  • Crushing is unsafe, as it destroys the active ingredients in the medication.
  • Crushing the medication would release all the medication at once, rather than over a sustained period. (correct)
  • Crushing the medication is a good idea, and I can mix it in some ice cream for you.
  • Crushing the medication might cause you to have a stomachache or indigestion.

A nurse starts a client's gentamicin infusion, programmed to infuse over one hour. Ten minutes later, the client reports dyspnea, generalized rash, and itchiness. What is the priority intervention?

  • Stop the infusion immediately. (correct)
  • Encourage the client to take deep breaths and remain calm.
  • Administer an IV fluid bolus to flush the medication.
  • Administer oxygen via nasal cannula.

Which of the following medications are used for contraception and/or prevention of pregnancy? (Select all that apply.)

  • Finasteride.
  • Medroxyprogesterone acetate (Depo-Provera). (correct)
  • Desogestrel (Mirena). (correct)
  • Ethinyl estradiol and drospirenone (Yaz). (correct)

A nurse is caring for a client who has sepsis and a prescription for vancomycin 1 g in 250 mL dextrose 5% (D5W) over 2 hr by IV intermittent bolus. To what rate in mL/hr should the IV pump be set?

<p>125 (C)</p> Signup and view all the answers

A nurse is preparing to administer amoxicillin 100 mg PO every 8 hr to a toddler who weighs 20 kg. The recommended dosage range is 20 to 25 mg/kg/day. Which action by the nurse is appropriate?

<p>The nurse administers the prescribed dosage. (B)</p> Signup and view all the answers

A client diagnosed with trichomoniasis is prescribed metronidazole (Flagyl). The nurse should instruct the client to avoid which contraindication associated with this medication?

<p>Alcohol (A)</p> Signup and view all the answers

The nurse is caring for a client with swelling to the distal phalanges, first big toe, and 10/10 pain. Which medication would be administered for this client's acute gout?

<p>Colchicine (D)</p> Signup and view all the answers

Which of the following is a common adverse effect associated with gentamicin therapy?

<p>Nephrotoxicity (B)</p> Signup and view all the answers

A client with a history of penicillin-induced rash is prescribed amoxicillin. Which action should the nurse prioritize?

<p>Consult the provider regarding an alternative antibiotic choice due to the cross-sensitivity. (B)</p> Signup and view all the answers

To minimize complications during vancomycin infusion, which nursing intervention is most appropriate?

<p>Administer the vancomycin infusion slowly, over a minimum of 60 minutes. (A)</p> Signup and view all the answers

A patient with an oral candida infection involving the roof of the mouth and throat has been prescribed nystatin suspension. What is the nurse's priority action?

<p>Shake the nystatin bottle vigorously to ensure uniform suspension of the medication. (A)</p> Signup and view all the answers

A nurse is educating a patient receiving intermittent intravenous metronidazole. Which condition warrants the use of this medication?

<p>As prophylaxis against infective endocarditis. (A)</p> Signup and view all the answers

A client with tuberculosis is being treated with isoniazid and rifampin. Which outcome is the MOST reliable indicator of adherence to the medication regimen?

<p>A negative sputum culture for <em>Mycobacterium tuberculosis</em>. (A)</p> Signup and view all the answers

A client diagnosed with a urinary tract infection (UTI) is prescribed sulfamethoxazole/trimethoprim (Bactrim). Which of the following conditions is a contraindication for this medication?

<p>Megaloblastic anemia (D)</p> Signup and view all the answers

A client has frequent infections with Strep throat. Which principle contributes to further bacterial resistance to antibiotics?

<p>Skipping dosages (C), Treating viral infections with antibiotics (D), Discontinuing antibiotics once symptoms subside (E), Frequent use of antibiotics (F)</p> Signup and view all the answers

The nurse is caring for a client receiving ciprofloxacin (Cipro) for treatment of a urinary tract infection (UTI). Which black box warning (BBW) will the nurse include in the discharge education?

<p>This drug has a black box warning for causing tendon rupture (A)</p> Signup and view all the answers

A client diagnosed with trichomoniasis is prescribed metronidazole (Flagyl). The nurse should instruct the client to avoid which substance due to a contraindication associated with this medication?

<p>Alcohol (B)</p> Signup and view all the answers

The nurse is caring for an immunosuppressed pediatric client who reports soreness in his mouth and refuses to eat. Inspection of his mouth reveals a white, milky plaque that does not come off with rubbing. The nurse should anticipate which drug to be administered to this client?

<p>nystatin (Mycostatin) (A)</p> Signup and view all the answers

A nurse is teaching a client who is beginning highly active antiretroviral therapy (HAART) for HIV which includes zidovudine (Retrovir). The nurse should include teaching regarding which black box warning associated with this medication?

<p>lactic acidosis (B)</p> Signup and view all the answers

A client diagnosed with strep throat requires antibiotics for treatment and has an allergy to penicillin. Which medication should be avoided due to cross-sensitivity with penicillin medications?

<p>Cephalosporins (A)</p> Signup and view all the answers

A nurse is caring for a client receiving doxycycline (Doryx) for the treatment of Lyme's Disease. Which instruction is most important to include?

<p>Limit sun exposure and wear protective clothing when outdoors. (D)</p> Signup and view all the answers

A client is prescribed gentamicin for a severe infection. What is a priority nursing intervention?

<p>Assessing for tinnitus, vertigo, and changes in hearing acuity. (B)</p> Signup and view all the answers

A nurse is providing discharge teaching to a client prescribed tetracycline. What statement indicates effective teaching?

<p>&quot;I should store this medication in a dark, dry place and discard any expired pills.&quot; (B)</p> Signup and view all the answers

Which of the following drug classes reduces the surface tension of stool, facilitating water penetration?

<p>Surfactant laxatives (A)</p> Signup and view all the answers

Which medication is primarily used to manage and alleviate diarrhea?

<p>Loperamide (A)</p> Signup and view all the answers

A client is prescribed doxycycline for a UTI. Which instructions are most important to include regarding potential side effects and interactions? (Select all that apply)

<p>This medication may cause photosensitivity (B), This medication should not be taken with antacids (C), This medication may cause discoloration of the teeth (D)</p> Signup and view all the answers

A client with a fungal infection is prescribed fluconazole. What potential side effect should the nurse include in client education?

<p>Increase in the client's liver panel. (A)</p> Signup and view all the answers

Which classes of antibiotics are associated with the potential for QT prolongation?

<p>Fluoroquinolones and Macrolides (C)</p> Signup and view all the answers

A client with active TB receives a new prescription for rifampin. Which common side effect should the nurse inform the client about?

<p>Orange-colored secretions (A)</p> Signup and view all the answers

What key teaching point should a nurse emphasize to a newly diagnosed TB client regarding their antitubercular medication regimen?

<p>A typical course of treatment involves 6 to 12 months of consistent medication use. (B)</p> Signup and view all the answers

A client newly prescriptioned rifampin (Rifadin), which is a key teaching point?

<p>Your urine and other bodily fluids may turn an orange color. (A)</p> Signup and view all the answers

A patient who has been started on doxycycline (Doryx), what should be avoided?

<p>Dairy products and antacids when taking this medication (D)</p> Signup and view all the answers

A patient who is taking fluconazole (Diflucan) for a fungal infection, what lab values should be monitored?

<p>Liver Function Tests (LFTs) (D)</p> Signup and view all the answers

Flashcards

Crushing Medications

Some medications should not be crushed as it alters their release.

Priority Intervention for Allergic Reaction

Stopping the infusion immediately is crucial for managing an allergic reaction.

Female Reproductive Medications

Ethinyl estradiol, drospirenone, Desogestrel, and Medroxyprogesterone are contraceptives.

Vancomycin IV Rate

Vancomycin 1g in 250mL over 2 hours means set the IV pump to 125 mL/hr.

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Amoxicillin Dosage for Toddler

Amoxicillin 100 mg PO every 8 hours for a 20 kg toddler is safe and has adequate dosage.

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Metronidazole Contraindication

Clients taking metronidazole should avoid alcohol to prevent adverse effects.

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Acute Gout Medication

For acute gout, medications like Febuxostat are used to relieve pain.

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Monitoring Allergic Reactions

Symptoms of dyspnea, rash, and itchiness indicate an allergic reaction requiring immediate action.

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Bactrim contraindications

Avoid Bactrim in cases of megaloblastic anemia.

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Antibiotic resistance causes

Discontinuing antibiotics early contributes to resistance.

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Skipping antibiotic doses

Skipping doses increases the risk of bacterial resistance.

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Ciprofloxacin black box warning

Ciprofloxacin may cause tendon rupture.

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Oral thrush treatment

Nystatin is used for oral thrush treatment in immunosuppressed patients.

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Zidovudine warning

Zidovudine can cause lactic acidosis as a side effect.

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Cross-sensitivity with penicillin

Cephalosporins should be avoided if allergic to penicillin.

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Doxycycline purpose

Doxycycline is used to treat Lyme's disease.

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Antibiotic resistance from viral treatments

Treating viral infections with antibiotics increases resistance.

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Amoxicillin Allergy Risk

If a client has a history of rash from penicillin, the nurse should consider alternatives before administering amoxicillin.

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Vancomycin Infusion Safety

To prevent complications with vancomycin, it should be infused over at least 1 hour.

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Nystatin Administration Order

Before giving nystatin for oral candida, instruct the client to swish the medication around in the mouth.

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Metronidazole Indications

Indications for intermittent parenteral metronidazole include specific infections, not conditions like kidney transplant.

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TB Medication Adherence

A negative sputum culture indicates adherence to tuberculosis medication like isoniazid and rifampin.

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Surfactant Laxatives

Medications like Docusate sodium that lower stool surface tension, aiding water penetration to soften stool.

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Doxycycline Side Effects

Doxycycline may cause tooth discoloration and should not be taken with antacids.

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Fluconazole Warning

Fluconazole may increase liver panel values; monitor liver function.

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QT Prolongation Antibiotics

Certain antibiotics, like fluoroquinolones and macrolides, can cause QT prolongation.

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Rifampin Color Change

Rifampin can cause orange-colored secretions as a side effect.

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Antitubercular Medication Duration

Treatment for tuberculosis generally lasts 6 to 12 months.

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Phototoxicity Warning

Doxycycline may cause photosensitivity; avoid sun exposure while on this drug.

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Diarrhea Prevention Medications

Medications like loperamide are used to prevent diarrhea.

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Lactating Caution for Antibiotics

Some antibiotics, like doxycycline, should not be used during lactation.

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Creatinine Clearance Monitoring

Fluconazole treatment may require monitoring for changes in creatinine clearance.

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Study Notes

Pharmacology Test 1

  • Misoprostol Administration: The next action for a nurse administering misoprostol to a pregnant client is to check with the provider for further clarification. Verify the client's identity and only administer the medication if the provider confirms it's the right route.

  • Baclofen Therapeutic Use: Baclofen is used to relieve spasticity related to conditions like cerebral palsy, spinal cord injury, and multiple sclerosis.

  • Conjugated Equine Estrogens (Premarin) Contraindications: Clients with a history of thromboembolic disease are contraindicated for conjugated equine estrogens (Premarin). Clients with a history of hypertension are also contraindicated. Clients with atypical vaginal bleeding that is not diagnosed should also not use this medication.

  • Tetracycline and Antacids: Taking tetracycline with antacids reduces tetracycline absorption. This is an antagonistic effect where one drug reduces the effect of another.

  • Cyclobenzaprine (Flexeril): This medication is used to relieve muscle spasms, not specifically for other conditions like malignant hyperthermia, osteoporosis, or migraines.

Additional Medication Information

  • Alendronate (Fosamax): Take this medication with water in the morning before eating. Do not take with antacids.

  • Enteric-Coated Aspirin: Crushing enteric-coated aspirin releases the medication all at once instead of over time. Do not crush this medication if the client has difficulty swallowing.

  • Gentamicin Infusion: If a client receiving gentamicin via IV reports dyspnea, rash, and itching, stop the infusion immediately as these are symptoms of an allergic reaction.

  • Female Reproductive Medications: Ethinyl estradiol and drospirenone (Yaz), Desogestrel (Mirena), and Medroxyprogesterone acetate (Depo-Provera) are examples of medications used for contraception and/or prevention of pregnancy.

  • Vancomycin: For a vancomycin prescription of 1g in 250mL D5W over 2 hours, the IV pump should be set to deliver 125mL/hr.

  • Amoxicillin: The recommended dosage range for amoxicillin in a 20kg toddler is 20-25mg/kg/day, which is equivalent to 400-500mg per day.

  • Metronidazole (Flagyl): Clients with trichomoniasis should not consume grapefruit juice, alcohol, and food containing tyramine.

  • Doxycycline (Doryx): Doxycycline can cause tooth discoloration. Avoid this medication if lactating. Do not take with antacids. Can cause photosensitivity, so use sunscreen. Should not be adminstered to anyone under 20yrs age.

  • Fluconazole: The nurse should caution clients about potential liver panel increases related to fluconazole.

  • Rifampin (Rifadin): Clients taking rifampin may experience orange-colored secretions, tooth staining, and changes in stool color.

  • Antibiotic Resistance: Avoid skipping or discontinuing antibiotics prematurely, and practice proper hand hygiene to help prevent resistance development.

  • Antibiotics and QT Prolongation: Antibiotics like fluoroquinolones and macrolides can prolong the QT interval.

  • Tuberculosis Medication Regimen Adherence: A negative sputum culture indicates adherence to the medication regimen for tuberculosis treatment.

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