N317 Exam 3 Review (Student Version) PDF

Exam 3 Review **[Acid-Controlling and Bowel Disorder Drugs]** **[Histamine 2 Receptor Antagonists:] cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid)** end in -tidine 1. What medication class is used if H2 blockers are not effective in relieving symptoms (i.e. what antacid medicat...

Exam 3 Review **[Acid-Controlling and Bowel Disorder Drugs]** **[Histamine 2 Receptor Antagonists:] cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid)** end in -tidine 1. What medication class is used if H2 blockers are not effective in relieving symptoms (i.e. what antacid medication is stronger)? Proton pump inhibitors (-prazoles) **[Proton Pump Inhibitors:] omeprazole (Prilosec), lansoprazole (Prevacid), pantoprazole (Protonix), rabeprazole (Aciphex), esomeprazole (Nexium)** end in -prazole 2. Side effects (x2): osteoporosis related fractures, CDAD **[Miscellaneous Antacids]:** **sucralfate (Carafate)** 3. Patient education: separate sucralfate from other medications by [ 2] hours. 4. Patient education: take this medication [ 4] times a day. Take [ 1] hour prior to meals, and at bedtime. 5. Side effects (x3): abdominal cramping, diarrhea, birth defects 6. These medications are to be avoided in what population? Pregnant people **[Antidiarrheals]** **[Absorbent:] bismuth subsalicylate (Pepto-Bismol)** 7. Side effects (x2): black or gray stools, constipation **[Opiates:] loperamide (Imodium A-D)** 8. Is this an over the counter or prescription medication? Over the counter 9. Side effects (x2): constipation, drowsiness **[Anticholinergic:]** **diphenoxylate atropine (Lomotil)** 10. What is the purpose of atropine in this medication combination? Discourage abuse since diphenoxylate can be abused **[Laxatives:]** **[Stool Softner/Emollient:] docusate (Colace)** 11. Use (prevention or maintenance): prevention **[Bulk-Forming Laxative:] methylcellulose (Citrucel), psyllium (Metamucil)** 12. Use: constipation prevention and maintainance 13. Patient education: add with 8 oz or more of water to prevent water from swelling too much and they can choke **[Stimulant Laxative:] senna (Senokot), bisacodyl (Dulcolax)** 14. Duration use (short term or long term): short term use **[Osmotic Laxative:] polyethylene glycol (MiraLAX)** 15. Duration use (short term or long term): short term use **[Antidiabetics]** 16. Signs and symptoms of hypoglycemia (x8): - Blood glucose less than 70 - sweating - confusion - lethargy - pale, cool, moist skin - weakness - anxiety 17. What actions do you take if you suspect a patient is experiencing hypoglycemia? Point of care glucose and then treat **[Biguanide:] metformin (Glucophage)** 18. Side effects (x5): diarrhea, nausea, vomiting, abdominal bloating, lactic acidosis 19. What medication should NOT be administered with this medication? IV dye/contrast - How long should metformin be held after giving the above medication? 48 hours **[Sulfonylureas:] 1^st^ generation ends in -mide: chlorpropamide (Diabinese), tolbutamide (Orinase), tolazamide (Tolinase). 2^nd^ generation ends in -ide: glimepiride (Amaryl), glipizide (Glucotrol), glyburide (DiaBeta)** 20. Side effect of both generations (x1): hypoglycemia 21. An allergy to what antibiotic class prevents use of this medication? sulfonamides **[Meglitinides]: end in -glinide, nateglinide (Starlix), repaglinide (Prandin)** 22. Side effect (x1): hypoglycemia **[Thiazolidinediones]: end in -glitazone, pioglitazone (Actos), rosiglitazone (Avandia)** 23. Side effects (x3): heart failure, liver failure, rhabdomyolysis 24. Patients with what diagnoses cannot take these medications (black box warning)? People with heart failure 25. Nursing implications (x3): cardiac history, LFTs, urine color and BLE assessment **[GLP-1 Agonist]: end in -tide, exenatide (Byetta), liraglutide (Victoza), semaglutide (Ozempic), dulaglutide (Trulicity)** 26. What route is this medication administered? SubQ 27. Side effects (x4): I&Os, GI assessment, amylase, lipase 28. Labs to monitor: amylase and lipase (pancreatic enzymes) **[SGLT2i]: end in -gliflozin, empagliflozin (Jardiance), canagliflozin (Invokana)** 29. Side effects (x2): urinary tract infections and genital signs/symptoms **[Insulin]** 30. At what point/time are we most concerned about a patient experiencing hypoglycemia following insulin administration? Insulin peak times 31. Lab to monitor prior to insulin administration? Point of care glucose level 32. Which insulin can be given IV? Regular insulin 33. Practice sliding scale: It is 1130, and your patient's meal tray just arrived. The point of care glucose has been obtained and was 321 mg/dL. How many units of Insulin Lispro are you going to administer? 4 units of insulin -  A screenshot of a computer Description automatically generated 34. Practice carb count: You are reviewing your patient's Medication Administration Record (MAR) and see that the patient has been ordered Carbohydrate (Carb) Count lispro (Humalog) insulin with a 1:4 insulin to carb ratio. You obtain the patient's meal ticket and note that they ate the following. How many units of lispro (Humalog) are you going to administer to the patient?  A table with text and numbers Description automatically generated - Carb count: 37 - Units of Insulin Lispro to administer: 8 units 35. Complete the following table: Generic Name Brand Name Class/ Action time Onset Peak Duration -------------- --------------------------- -------------------- ----------------------- ------------ --------------- glulisine Apidra Rapid/fast *15-30 min* *1 hour* *3-4* aspart Novolog Rapid/fast 15 min 1-3 hours *3-5 hours* lispro Humalog Rapid/fast 5-15 min 0.5-1 hour *3-4 hours* regular Humulin R, Novolin R short 30-60min 2-4 hours *5-7 hours* isophane NPH, Humulin N, Novolin N intermediate 1-2 hrs 4-12 hours *18-24 hours* detemir Levemir long *Gradual over 24 hrs* 6-8 hours *24 hours* glargine Lantus long gradual No peak *24 hours* **[Hypoglycemic Agents]** 36. **Dextrose (Glucose)**: what route is this administered? PO 37. **glucagon**: what route is this administered? IM, subQ 38. **10% or 50% dextrose**: what route is this administered? IV or IVP **[Antidepressants/Anxiolytics]** 39. Patient education when starting an antidepressant (symptom relief)*:* do not stop taking meds abruptly and there needs to be 2 weeks between starting a new med. **[Monoamine Oxidase Inhibitors (MAOIs):] phenelzine (Nardil), tranylcypromine (Parnate), isocarboxazid (Marplan), selegiline (Emsam)** 40. Side effects (x3): hypertensive crisis, serotonin syndrome, sedation/drowsiness 41. Patient education: - Diet: avoid foods high in tyramine (beer, cheese, processed meats) - Medications: avoid medications high in tyramine - How long before and after taking a MAOI should a patient avoid these foods/medications? Two weeks before starting and two weeks after its discontinued 42. Signs of hypertensive crisis (x5): severe headache, chest pain, tachycardia, enlarged pupils, sweating **[Tricyclic Antidepressants]: end in -tryptyline, amitriptyline (Elavil), nortriptyline (Pamelor):** 43. Side effects (x3): anticholinergic effects, sedation/drowsiness, serotonin syndrom 44. Anticholinergic effects (x4): blurred vision, urinary retention, dry mouth, constipation **[Selective Serotonin Reuptake Inhibitors:] citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft): [ ]** 45. Side effects (x3): sexual dysfunction, serotonin syndrome, insomnia 46. Two medications FDA approved to treat pediatric patients with depression: escitalopram (Lexapro), fluoxetine(Prozac) **[Serotonin Norepinephrine Reuptake Inhibitors]: duloxetine (Cymbalta), venlafaxine (Effexor), desvenlafaxine (Pristiq)** 47. What other conditions do we see duloxetine (Cymbalta) utilized as a treatment for? Chronic pain **[Atypical Antidepressant:] bupropion (Wellbutrin)** 48. Medication can also be used for: quitting smoking - Patient education regarding this condition: do not quit smoking until 2^nd^ week of using medication 49. Side effects (x2): insomnia, weightloss **[Anxiolytic Drugs: benzodiazepines:] (-pam and -lams)[: \[]**[Long acting\] clonazepam (Klonopin), diazepam (Valium)**,** \[Intermediate acting\] lorazepam (Ativan), temazepam (Restoril), alprazolam (Xanax)**,** \[Short acting\] midazolam (Versad)] 50. Controlled substance class: IV (4) 51. Side effects (x4): sedation/drowsiness, bradycardia, hypotension, decreased respiratory rate 52. Antidote: flumazenil (romazicon) 53. Nursing Implications*:* LOC, vitals **[Psychotherapeutic drugs]** **[Mood Stabilizer:] lithium (Lithoid)** 54. Labs to monitor (x3): lithium level, sodium level, renal function 55. Side effects (x3): weight gain, sedation, lithium toxicity 56. Common cause of lithium toxicity: narrow therapeutic range - Patient education to prevent lithium toxicity (x3): drink enough water, do not limit sodium levels, labs 2x a week for 2 weeks then every other month - Symptoms of severe toxicity (x1): dehydration **[First Generation (Typical) Antipsychotics:] chlorpromazine (Thorazine), prochlorperazine (Compazine)** 57. Side effects (x3): anticholinergic effects, Neuroleptic malignant syndrome, Extrapyramidal symptoms 58. Black box warning (for 1^st^ and 2^nd^ generation): increase risk of mortality at age 65 or greater **[Second Generation (Atypical) Antipsychotics:] clozapine (Clozaril), [ ] quetiapine (Seroquel), risperidone (Risperdal), olanzapine (Zyprexa)** 59. These medications are contraindicated with what diagnosis? dementia 60. Side effects of all 2^nd^ generation atypical antipsychotics (x3): sedation, weight gain, neuroleptic malignant syndrome **[Extrapyramidal Symptoms (EPS)]** 61. Symptoms (x4): pseudo parkinsonism, acute dystonia, akathisia, tardive dyskinesia 62. Can these symptoms be reversed? yes **[Neuroleptic Malignant Syndrome: ]** 63. Symptoms (x6): altered mental status, very high fever, heart arrythmias, labile hypertension, lead pipe muscle rigidity, excessive sweating 64. Typical onset of symptoms: 1 week **[Serotonin Syndrome:]** 65. Signs/Symptoms (x8): mydriasis, pressured speech, hypertension, tachycardia, diarrhea, shivering/shaky, agitation, diaphoresis - Severe symptoms (x3): fever, muscle rigidity, seizures 66. Typical onset of symptoms: 6 hours after starting med or after dose increase **[Prostaglandin synthesis inhibitors: Acetaminophen (Tylenol):]** 67. Max dose for normal liver function: 3,000-4,000mg 68. Max dose with liver disease/chronic alcohol use: 2,000 mg 69. Side effect (x1): hepatoxicity **[Non-Steroidal Anti-Inflammatory (NSAID):] ibuprofen (Advil/Motrin), naproxen (Aleve)** 70. Side effects (x2): GI bleed, renal failure 71. Max dose of ibuprofen: 3,200mg 72. Ketorolac (Toradol) can only be used for [ 5] days max. **[Opioid Agonists: ]** **[Moderate pain:] codeine, hydrocodone, oxycodone (Oxycontin):** 73. Side effects (x4): sedation, hypotension, constipation, respiratory depression 74. Nursing implications (x3): LOC, vitals, GI assessment **[Severe pain:] fentanyl, hydromorphone (Dilaudid), morphine, meperidine (Demerol)** 75. Controlled substance class: Class II (2) 76. Side effects (x4): sedation, hypotension, constipation, respiratory depression 77. Your patient is prescribed a Fentanyl patch. What education do you need to provide about administration of the patch? Dispose patch in safe container, no chewing, swallowing, snorting, or injecting med **[Opioid Antagonists:] naloxone (Narcan) [ ]** 78. Side effects (x1): ventricular arrythmias 79. When should pain be monitored for this medication? After administration **[Substance Abuse]** **[Opioid Agonist-Antagonist:] buprenorphine** 80. What class scheduled medication is this: Class III (3) **[Partial agonist/antagonist:] buprenorphine-naloxone (Suboxone)** 81. What route is this medication administered? Under the tongue (sublingual) 82. What controlled substance class is this medication? Class III (3) 83. Why is naloxone added to this medication? Reduce addiction risk **[Opioid agonist]: methadone (Methadose): [ ]** 84. What condition is this medication used for: opioid use disorder 85. What scheduled class is this medication? Class II (2) **[Opioid Antagonist: naltrexone (Vivitrol), naltrexone]** 86. How long do patients need to be free of opioids prior to use? 1 weel 87. How long do patients need to free of alcohol prior to use? pt should be through alcohol detox **[Alcohol Withdrawal]** 88. What scale is used to monitor patients at risk for or currently experiencing alcohol withdrawal? CIWA 89. What medication is used to treat findings from CIWA assessment? Lorazepam(Ativan) 90. Practice CIWA (scale provided below, you will never need to memorize the scale). Patient assessment findings as follows: Patient reports no nausea, mildy anxious, mild pins and needles, very mild light sensitivity, moderate headache. Your assessment findings include beads of sweat on the forehead, no visible tremor but can be felt with touch, unable to startle, fully oriented, with somewhat normal activity. -   - What score do you assign this patient? 13 - Based on the following order (below), and knowing that the RASS score is +1, what route and dose of lorazepam will you administer? 1mg PO - A close up of a prescription Description automatically generated **[Insomnia nonbenzodiazepine:] zolpidem (Ambien or Ambien CR)** 91. Which of the two brand name medications helps with both initiating sleep and staying asleep? Ambien CR 92. What controlled substance class is this medication? IV (4) **[Sedative/Hypnotic:] eszopiclone (Lunesta)** 93. What does this treat (initiating sleep, staying asleep, or both)? both **[Muscle Relaxants]** **[Antispasmodic:] carisoprodol (Soma), cyclobenzaprine (Flexeril), metaxalone (Skelaxin), methocarbamol (Robaxin)** 94. What type of pain do these medications treat? Muscle pain 95. Side effects (x2): drowsiness, dizziness **[Antispastic:] baclofen** 96. If the oral medication route is not helping to relieve symptoms, what other route of administration can this medication be? Intrathecal pump **[CNS Stimulants]** **[ADHD:] amphetamine mixture (Adderall/Adderall XR), dexmethylphenidate (Focalin/Focalin XR), dextroamphetamine (Dexedrine), methylphenidate (Ritalin/Ritalin XR), lisdexamfetamine (Vyvanse)** 97. What controlled substance class are these medications? Class II 98. Describe a drug holiday and its purpose: to see if there are concerns regarding a childs weight loss due to appetite supression 99. Nursing implications (x5): assess attention span, nutritional status, blood pressure, sleep status, pulse **[ADHD Other:] atomoxetine (Strattera)** 100. What controlled substance class is this medication? Not a controlled substance 101. Patient education (x1): do not take with other vasoconstricting drugs **[Migraine Abortive Medications]: all end in -triptan: sumatriptan (Imitrex), rizatriptan (Maxalt)** 102. Nursing implications (x1): cardiac history review 103. Patient education: does not prevent migraines, aborts them **[Antiepileptic]** 104. Nursing assessments for all antiepileptic (x2): monitor for seizure activity and suicidal thoughts **[Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)]** 105. When is this reaction most likely to occur? 2 to 6 weeks after starting med 106. Symptoms/Side effects (x5): extensive rash, elevated eosinophils, swollen lymph nodes, kidney and/or liver injury 107. Labs to monitor: CBC w/ diff, CMP **[Barbiturates:] pentobarbital (Nembutal), phenobarbital (Luminal)** 108. Are these controlled substance medications? Yes, Pentobarbitol ( II), phenobarbital (IV) **[Hydantoins:] phenytoin (Dilantin- PO and IV), fosphenytoin (Cerebyx- IV and IM)** 109. Side effect (x1): gingival hyperplasia 110. Patient education (diet): need to increase folic acid and vitamin D/calcium. Drink fortified milk 111. Patient education (oral care): begin vigorous cleaning within 10 days but no flossing vigorously. Use soft bristle brush 112. When are labs drawn to assess drug levels (ensuring patient is in therapeutic range): CBC phenytoin levels 113. Symptoms of phenytoin toxicity (x3): ataxia, hand tremor, slurred speech **[Miscellaneous:]** **gabapentin (Neurontin)** 114. Is this medication used alone for management of epilepsy? Its an add on 115. What other conditions is this medication used as a treatment for? Peripheral neuropathy **lamotrigine (Lamictal)** 116. Side effects (x1): photosensitivity 117. Patient education: use sunglasses, hat, long sleeve, wear sun screen especially between 10am to 4pm **valproic acid (Depakene)** 118. Side effects (x1): hepatoxicity 119. Patient education*:* do not drink with milk and do not drink with carbonated drinks **[Antiparkinson Drug]** **[Dopamine replacement:] carbidopa-levodopa (Sinemet)** 120. Explain why carbidopa is combined with levodopa. It helps cross the blood brain barrier when combined 121. Patient education (diet): decrease protein in diet **[Anticholinergic drugs: cholinergic blocker;] benztropine (Cogentin)** 122. Side effects (anticholinergic, x4): dry mouth, urinary retention, blurred vision, constipation **[Alzheimer Drugs]** 123. What changes in acetylcholine are seen in Alzheimer\'s Disease? increasing levels **[Cholinesterase inhibitor:] donepezil (Aricept)** 124. When should this medication be started? When pt is diagnosed 125. Side effects (x1): diarrhea **[NMDA antagonist:] memantine (Namenda)** 126. Nursing implications for all Anti-Alzheimer meds: cognitive function