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Questions and Answers
What is the primary mechanism of action of H1-receptor antagonists in the treatment of allergic rhinitis?
What is the primary mechanism of action of H1-receptor antagonists in the treatment of allergic rhinitis?
- They block the actions of histamine at H1 receptors. (correct)
- They constrict blood vessels in the nasal mucosa.
- They stimulate the release of histamine from mast cells and basophils.
- They increase the secretion of inflammatory mediators.
Which of the following is a common adverse effect of first-generation antihistamines?
Which of the following is a common adverse effect of first-generation antihistamines?
- Nasal congestion
- Drowsiness (correct)
- Increased mucus secretion
- Vasoconstriction
What is the primary action of mucolytics in the treatment of respiratory disorders?
What is the primary action of mucolytics in the treatment of respiratory disorders?
- They constrict blood vessels in the lungs.
- They loosen thick, viscous bronchial secretions. (correct)
- They stimulate the cough reflex.
- They decrease the secretion of inflammatory mediators.
Which of the following is a contraindication for the use of intranasal corticosteroids?
Which of the following is a contraindication for the use of intranasal corticosteroids?
What is the primary mechanism of action of beta-adrenergic agonists in the treatment of asthma?
What is the primary mechanism of action of beta-adrenergic agonists in the treatment of asthma?
Which of the following is a potential adverse effect of cough suppressants?
Which of the following is a potential adverse effect of cough suppressants?
What is the primary action of expectorants in the treatment of respiratory disorders?
What is the primary action of expectorants in the treatment of respiratory disorders?
Which of the following is a characteristic of second-generation antihistamines?
Which of the following is a characteristic of second-generation antihistamines?
What is the primary use of inhaled corticosteroids in the treatment of allergic rhinitis?
What is the primary use of inhaled corticosteroids in the treatment of allergic rhinitis?
Which of the following is a nursing consideration for patients using mucolytics?
Which of the following is a nursing consideration for patients using mucolytics?
What is the primary cause of weakened bone in osteoporosis?
What is the primary cause of weakened bone in osteoporosis?
What is the therapeutic class of Colchicine?
What is the therapeutic class of Colchicine?
What is the most common site for gout to occur?
What is the most common site for gout to occur?
What is the primary mechanism of action of calcium salts in the treatment of hypocalcemia?
What is the primary mechanism of action of calcium salts in the treatment of hypocalcemia?
What is the primary reason Colchicine is reserved for?
What is the primary reason Colchicine is reserved for?
What is the primary adverse effect of alendronate that is rare but serious?
What is the primary adverse effect of alendronate that is rare but serious?
What is the primary action of Colchicine in the treatment of gout?
What is the primary action of Colchicine in the treatment of gout?
What is a common adverse effect of Colchicine?
What is a common adverse effect of Colchicine?
What is the primary mechanism of action of hydroxychloroquine in the treatment of autoimmune disorders?
What is the primary mechanism of action of hydroxychloroquine in the treatment of autoimmune disorders?
What is the primary adverse effect of methotrexate that is related to the gastrointestinal system?
What is the primary adverse effect of methotrexate that is related to the gastrointestinal system?
What is the recommended route of administration for Colchicine?
What is the recommended route of administration for Colchicine?
What is the primary mechanism of action of allopurinol in the treatment of chronic gout?
What is the primary mechanism of action of allopurinol in the treatment of chronic gout?
What is the primary nursing consideration for patients taking calcium salts?
What is the primary nursing consideration for patients taking calcium salts?
What is the primary contraindication for the use of alendronate?
What is the primary contraindication for the use of alendronate?
What is the primary adverse effect of xanthine oxidase inhibitors that is related to the kidneys?
What is the primary adverse effect of xanthine oxidase inhibitors that is related to the kidneys?
When is the pain typically worsened for patients with gastric ulcers?
When is the pain typically worsened for patients with gastric ulcers?
What is the primary action of proton pump inhibitors in the treatment of peptic ulcer disease?
What is the primary action of proton pump inhibitors in the treatment of peptic ulcer disease?
When should proton pump inhibitors be taken?
When should proton pump inhibitors be taken?
What is the primary therapeutic use of alosetron?
What is the primary therapeutic use of alosetron?
What is the primary mechanism of action of antacids in the treatment of peptic ulcer disease?
What is the primary mechanism of action of antacids in the treatment of peptic ulcer disease?
When should antacids be taken in relation to other medications?
When should antacids be taken in relation to other medications?
What is the primary adverse effect of diphenoxylate with atropine?
What is the primary adverse effect of diphenoxylate with atropine?
What is the primary indication for the use of alosetron?
What is the primary indication for the use of alosetron?
How do antidiarrheal medications like diphenoxylate with atropine work?
How do antidiarrheal medications like diphenoxylate with atropine work?
What is the primary evaluation of effectiveness for proton pump inhibitors?
What is the primary evaluation of effectiveness for proton pump inhibitors?
What is the effect of cardiac glycosides on the heart rate?
What is the effect of cardiac glycosides on the heart rate?
What is the primary indication for the use of digoxin?
What is the primary indication for the use of digoxin?
What is the effect of cardiac glycosides on the gastrointestinal system?
What is the effect of cardiac glycosides on the gastrointestinal system?
What is the significance of frequent serum checks in patients taking digoxin?
What is the significance of frequent serum checks in patients taking digoxin?
What is the contraindication for the use of digoxin in patients with ventricular dysrhythmias?
What is the contraindication for the use of digoxin in patients with ventricular dysrhythmias?
What is the effect of verapamil on serum levels of digoxin?
What is the effect of verapamil on serum levels of digoxin?
What is the nursing consideration for patients taking digoxin?
What is the nursing consideration for patients taking digoxin?
What is the interaction between digoxin and diuretics?
What is the interaction between digoxin and diuretics?
What is the result of blood backing up into the lungs due to left-sided heart failure?
What is the result of blood backing up into the lungs due to left-sided heart failure?
What is the primary mechanism of action of cardiac glycosides in the treatment of heart failure?
What is the primary mechanism of action of cardiac glycosides in the treatment of heart failure?
What is the recommended frequency of serum checks for patients taking digoxin?
What is the recommended frequency of serum checks for patients taking digoxin?
What is the primary adverse effect of cardiac glycosides that is related to the gastrointestinal system?
What is the primary adverse effect of cardiac glycosides that is related to the gastrointestinal system?
What is the interaction between digoxin and verapamil?
What is the interaction between digoxin and verapamil?
What is the primary contraindication for the use of digoxin?
What is the primary contraindication for the use of digoxin?
What is the nursing consideration for patients taking digoxin?
What is the nursing consideration for patients taking digoxin?
What is the result of the interaction between digoxin and diuretics?
What is the result of the interaction between digoxin and diuretics?
What is the primary reason for monitoring INR levels in patients taking warfarin?
What is the primary reason for monitoring INR levels in patients taking warfarin?
What is the therapeutic class of warfarin?
What is the therapeutic class of warfarin?
Which of the following herbal medications may interact with warfarin to increase the risk of bleeding?
Which of the following herbal medications may interact with warfarin to increase the risk of bleeding?
What is the normal range for aPTT levels in patients not on heparin?
What is the normal range for aPTT levels in patients not on heparin?
What is the primary reason for monitoring platelet counts in patients with thrombocytopenia?
What is the primary reason for monitoring platelet counts in patients with thrombocytopenia?
What is the primary contraindication for the use of warfarin in patients with recent trauma?
What is the primary contraindication for the use of warfarin in patients with recent trauma?
What is the pregnancy category of warfarin?
What is the pregnancy category of warfarin?
What is the primary mechanism of action of dabigatran?
What is the primary mechanism of action of dabigatran?
Which of the following is a contraindication for the use of rivaroxaban?
Which of the following is a contraindication for the use of rivaroxaban?
What is the primary action of heparin?
What is the primary action of heparin?
What is the primary adverse effect of heparin?
What is the primary adverse effect of heparin?
What is the interaction between heparin and oral anticoagulants?
What is the interaction between heparin and oral anticoagulants?
What is the primary laboratory test used to monitor heparin therapy?
What is the primary laboratory test used to monitor heparin therapy?
What is the antidote for heparin overdose?
What is the antidote for heparin overdose?
What is the primary nursing consideration for patients taking dabigatran?
What is the primary nursing consideration for patients taking dabigatran?
Which type of diabetes is characterized by insulin resistance?
Which type of diabetes is characterized by insulin resistance?
What is the therapeutic class of levothyroxine?
What is the therapeutic class of levothyroxine?
What is the adverse effect of corticosteroids that is characterized by buildup of fluid in the lower legs?
What is the adverse effect of corticosteroids that is characterized by buildup of fluid in the lower legs?
What is the timing of administration for levothyroxine?
What is the timing of administration for levothyroxine?
What is the prototype drug for thyroid hormone replacement?
What is the prototype drug for thyroid hormone replacement?
What is the mechanism of action of insulin aspart and lispro?
What is the mechanism of action of insulin aspart and lispro?
What is the onset of action for insulin glargine and detemir?
What is the onset of action for insulin glargine and detemir?
What is the contraindication for the use of thyroid hormone in the treatment of obesity or weight loss?
What is the contraindication for the use of thyroid hormone in the treatment of obesity or weight loss?
What is the adverse effect of sulfonylureas that is characterized by weight gain?
What is the adverse effect of sulfonylureas that is characterized by weight gain?
What is the nursing consideration for patients taking insulin, in terms of evaluating effectiveness?
What is the nursing consideration for patients taking insulin, in terms of evaluating effectiveness?
What is the primary mechanism of action of levothyroxine in the treatment of hypothyroidism?
What is the primary mechanism of action of levothyroxine in the treatment of hypothyroidism?
What is the primary adverse effect of corticosteroids that is related to bone health?
What is the primary adverse effect of corticosteroids that is related to bone health?
What is the onset of action of insulin aspart and lispro?
What is the onset of action of insulin aspart and lispro?
What is the primary contraindication for the use of thyroid hormone in the treatment of obesity or weight loss?
What is the primary contraindication for the use of thyroid hormone in the treatment of obesity or weight loss?
What is the primary mechanism of action of fludrocortisone in the treatment of adrenocortical insufficiency?
What is the primary mechanism of action of fludrocortisone in the treatment of adrenocortical insufficiency?
What is the primary consequence of abrupt discontinuation of antiseizure medication?
What is the primary consequence of abrupt discontinuation of antiseizure medication?
What is the primary mechanism of action of phenobarbital in the treatment of seizures?
What is the primary mechanism of action of phenobarbital in the treatment of seizures?
What is the primary adverse effect of diazepam (Valium) that is related to its use in the short term?
What is the primary adverse effect of diazepam (Valium) that is related to its use in the short term?
What is the antidote for benzodiazepine overdose?
What is the antidote for benzodiazepine overdose?
What is the primary reason for the importance of compliance with antiseizure medication regimens?
What is the primary reason for the importance of compliance with antiseizure medication regimens?
What is the primary consequence of increased levels of acetylcholine in patients with Parkinson's disease?
What is the primary consequence of increased levels of acetylcholine in patients with Parkinson's disease?
What is the primary therapeutic class of phenobarbital?
What is the primary therapeutic class of phenobarbital?
What is the primary mechanism of action of Levodopa in the treatment of Parkinson's disease?
What is the primary mechanism of action of Levodopa in the treatment of Parkinson's disease?
What is the primary adverse effect of Pramipexole?
What is the primary adverse effect of Pramipexole?
What is the primary mechanism of action of Latanoprost in the treatment of glaucoma?
What is the primary mechanism of action of Latanoprost in the treatment of glaucoma?
Why is Latanoprost contraindicated in patients with closed-angle glaucoma?
Why is Latanoprost contraindicated in patients with closed-angle glaucoma?
What is the primary adverse effect of Timolol?
What is the primary adverse effect of Timolol?
What is the primary mechanism of action of Mementine in the treatment of Alzheimer's disease?
What is the primary mechanism of action of Mementine in the treatment of Alzheimer's disease?
What is the primary nursing consideration for patients taking Pramipexole?
What is the primary nursing consideration for patients taking Pramipexole?
What is the primary contraindication for the use of Timolol?
What is the primary contraindication for the use of Timolol?
What is the primary effect of androgens on male reproductive function?
What is the primary effect of androgens on male reproductive function?
What is the primary contraindication for the use of testosterone in men?
What is the primary contraindication for the use of testosterone in men?
What is the primary mechanism of action of PDE-5 inhibitors in the treatment of erectile dysfunction?
What is the primary mechanism of action of PDE-5 inhibitors in the treatment of erectile dysfunction?
What is the primary adverse effect of testosterone therapy that is related to the liver?
What is the primary adverse effect of testosterone therapy that is related to the liver?
What is the primary reason for monitoring BP and weight in patients taking testosterone therapy?
What is the primary reason for monitoring BP and weight in patients taking testosterone therapy?
What is the primary indication for the use of testosterone therapy in men?
What is the primary indication for the use of testosterone therapy in men?
What is the primary nursing consideration for patients taking testosterone therapy?
What is the primary nursing consideration for patients taking testosterone therapy?
What is the primary mechanism of action of alpha 1 adrenergic blockers in the treatment of benign prostatic hyperplasia?
What is the primary mechanism of action of alpha 1 adrenergic blockers in the treatment of benign prostatic hyperplasia?
What is the primary consequence of not donating blood while taking 5-Alpha reductase inhibitors?
What is the primary consequence of not donating blood while taking 5-Alpha reductase inhibitors?
What is the primary indication for the use of Antibiotics in the treatment of Chlamydia?
What is the primary indication for the use of Antibiotics in the treatment of Chlamydia?
What is the primary risk factor for the transmission of Human Papillomavirus?
What is the primary risk factor for the transmission of Human Papillomavirus?
What is the primary mechanism of action of 5-Alpha reductase inhibitors in the treatment of benign prostatic hyperplasia?
What is the primary mechanism of action of 5-Alpha reductase inhibitors in the treatment of benign prostatic hyperplasia?
What is the primary consequence of taking nitrates with phosphodiesterase inhibitors?
What is the primary consequence of taking nitrates with phosphodiesterase inhibitors?
What is the primary indication for the use of Penicillin in the treatment of Syphilis?
What is the primary indication for the use of Penicillin in the treatment of Syphilis?
What is the primary mechanism of action of phosphodiesterase inhibitors in the treatment of erectile dysfunction?
What is the primary mechanism of action of phosphodiesterase inhibitors in the treatment of erectile dysfunction?
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Study Notes
Respiratory Advantages/Disadvantages of Inhalation Route
- Antihistamines (H1-receptor antagonists) block actions of histamine at H1 receptor
- Widely used as OTC remedies for relief of allergy symptoms
- Examples: fexofenadine (Allegra), loratidine (Claritin), cetirizine (Zyrtec)
Antihistamines
- H1-receptor antagonists
- Examples: Diphenhydramine, Hydroxyzine
- Adverse effects: Anti-cholinergic effects, Sedation
Intranasal Corticosteroids
- Decrease secretion of inflammatory mediator
- Reduce tissue edema (inflammation)
- Cause mild vasoconstriction
- Treatment of perennial allergic rhinitis
- Prototype drug: Fluticasone (Flonase)
Mucolytics
- Directly loosen thick, viscous bronchial secretions
- Break down chemical structure of mucus molecules
- Mucus becomes thinner and can be removed more easily by coughing
- Prototype drug: Acetylcysteine (Mucomyst)
Cough Suppressants (Antitussives)
- Dampen cough reflex
- Used for coughs due to allergies or common cold
- Do not use for emphysema, bronchitis, liquid aspiration
- Prototype drug: Dextromethorphan (Delsym, Robitussin DM)
Asthma Rescue Drugs - Beta-Adrenergic Agonists
- Activate the sympathetic nervous system
- Relaxes bronchial smooth muscle
- Bronchodilation, widening the airway, making breathing easier
- Prototype drug: Albuterol (ProAir)
Musculoskeletal Disorders and Medications
- Gout
- Treatment: Colchicine (anti-gout drug, decreases inflammation caused by gout)
- Adverse effects: GI toxicity, bone marrow suppression
- Hypocalcemia
- Treatment: Calcium salts (calcium supplement)
- Adverse effects: Hypercalcemia, spasms
- Osteoporosis
- Treatment: Biphosphonates (suppress activity of osteoclasts, inhibit bone resorption)
- Adverse effects: Esophageal irritation, GI issues, hypocalcemia
- Prototype drug: Alendronate (Fosamax)
- DMARDs (Disease-modifying antirheumatic drugs)
- Examples: Hydroxychloroquine (Plaquenil), Methotrexate
- Adverse effects: GI upset, loss of hair, anorexia, headaches, mood changes, ocular effects
Gastrointestinal Disorders and Medications
- Peptic Ulcer Disease (PUD)
- Treatment: Proton pump inhibitors (reduce acid secretion in the stomach)
- Prototype drug: Omeprazole (Prilosec)
- Adverse effects: Generally minor
- Irritable Bowel Syndrome with Diarrhea (IBS-D)
- Treatment: Alosetron (selective blockade of 5-HT3 receptors)
- Adverse effects: Constipation, GI toxicity
- Contraindications: Chronic constipation, history of bowel obstruction
- Antidiarrheal
- Examples: Diphenoxylate with atropine, Loperamide
- Mechanism of action: Decrease intestinal motor activity, decrease fluid secretion, enhance mucosal absorption
Cardiovascular Disorders and Medications
- Heart Failure
- Treatment: Cardiac glycosides (positive inotropic effect, negative chronotropic effect, improved stroke volume and cardiac output)
- Prototype drug: Digoxin
- Adverse effects: Dysrhythmias, cardiotoxicity
- Anticoagulants
- Examples: Warfarin, Dabigatran (Pradaxa), Rivaroxaban (Xarelto)
- Adverse effects: Bleeding
- Interactions: Many medications and herbals
Coagulation Disorders and Medications
- Thrombocytopenia
- Treatment: Oral anticoagulants (inhibit action of vitamin K, synthesis of clotting factors)
- Prototype drug: Warfarin
- Adverse effects: Bleeding
- Interactions: Many medications and herbals
- Heparin (parenteral anticoagulant, indirect thrombin inhibitor)
- Adverse effects: Bleeding, heparin-induced thrombocytopenia (HIT)
Endocrine Disorders and Medications
- Diabetes Mellitus
- Treatment: Insulin (Type 1 and 2), Oral hypoglycemics (Type 2)
- Adverse effects: Hypoglycemia
- Prototype drug: Aspart (NovoLog), Lispro (Humalog)
- Thyroid Disorders
- Hypothyroidism
- Treatment: Thyroid hormone replacement
- Prototype drug: Levothyroxine (Synthroid)
- Hyperthyroidism
- Treatment: Beta blockers, thionamides
- Hypothyroidism
- Adrenal Disorders
- Cushing's syndrome
- Treatment: Corticosteroids (reduce inflammation)
- Prototype drug: Hydrocortisone
- Addison's disease
- Treatment: Mineralocorticoids (mimic effects of natural mineralocorticoids)
- Prototype drug: Fludrocortisone### Endocrine Disorders and Medications
- Cushing's syndrome
- Diabetes Mellitus:
- Type 1: totally insulin dependent
- Type 2: insulin resistant
- Cushing's Syndrome:
- ACTH production and corticosteroid medications
- Hypo/Hyperthyroidism:
- Hyperthyroidism: excessive T3 and T4, leading to increased metabolism
- Hypothyroidism: insufficient T3 and T4, leading to decreased metabolism
- Levothyroxine:
- Mechanism of action: thyroid hormone replacement
- Adverse effects: hyperthyroidism effects
- Nursing considerations: serum TSH levels, timing of administration, and black box warning
Corticosteroids
- Hydrocortisone:
- Mechanism of action: reduces inflammation
- Adverse effects: fluid buildup, high blood pressure, and upset stomach
- Nursing considerations: monitor bone pain and bone health, toxicity, and long-term use
- Fludrocortisone:
- Mechanism of action: mimics natural mineralocorticoids
- Adverse effects: retention of sodium and water
- Nursing considerations: monitor weight, BP, breath sounds, and urine output, and contraindications
Insulin
- Type 1 Diabetes:
- Aspart, Lispro, Regular, NPH, Glargine, and Detemir
- Onset, peak, and duration for each type
- Adverse effects: hypoglycemic effects
- Nursing considerations: S/S of hypoglycemia, evaluation of effectiveness, and blood glucose checks
Neurological Disorders and Medications
- Parkinson's Disease:
- Decreased dopamine and increased acetylcholine levels
- Medication classes: dopamine-enhancing drugs, NMDA receptor antagonists, and anticholinergics
- Seizures:
- Medication classes: antiseizure drugs, sedatives, and antidepressants
- Adverse effects: rebound effects, adrenal gland atrophy
- Nursing considerations: compliance, timing of administration, and controlled substance schedule
Dopamine Enhancing Drugs
- Levodopa:
- Mechanism of action: restores dopamine
- Adverse effects: uncontrolled movements, loss of appetite, nausea, and orthostatic hypotension
- Nursing considerations: may be unable to self-medicate, do not abruptly withdraw
Prostaglandin Analogs
- Latanoprost:
- Mechanism of action: enhances outflow of aqueous humor to lower IOP
- Adverse effects: local effects within the ocular region
- Nursing considerations: remove contacts and avoid touching the eye or eyelashes with the dropper
Male/Female Reproductive Disorders
- Hypogonadism:
- Lack of sufficient testosterone secretion
- Symptoms: diminished appearance of secondary sex characteristics, erectile dysfunction, and low sperm counts
- Androgens:
- Mechanism of action: supports male reproductive function
- Adverse effects: increase/decrease libido, fluid retention, edema, liver damage, and virilization
- Contraindications: known/suspected prostatic carcinomas, pregnancy, and pre-existing prostatic enlargement
Erectile Dysfunction
- PDE-5 Inhibitors:
- Mechanism of action: blocks PDE-5 enzyme to increase blood flow to the penis
- Adverse effects: hypotension, headaches, flushing, nasal congestion, priapism, and sudden hearing loss
- Nursing considerations: rapid onset, avoid high-fat meals and grapefruit juice
Benign Prostatic Hyperplasia
- Alpha 1 Adrenergic Blockers:
- Mechanism of action: opens the prostate for outflow of urine and relaxes smooth muscle
- Adverse effects: hypotension
- Nursing considerations: monitor BP, rise slowly from sitting/lying position, and first dose phenomenon
Chlamydia
- Symptoms: silent symptoms, Chlamydial conjunctivitis, and Chlamydial pneumonia
- Assessment: risk factors, emotional support, partner awareness, and education
- Medications: antibiotics
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