Part 5 Drugs

The ABC’s of PASSING FOREIGN NURSING EXAMS…………...…As prepared by R.A. Gapuz

PART V THE CHECK PRINCIPLE APPLIED IN PHARMACOLOG PHARMACOLOGY Y Remember to take your Tagamet with meals!

Oftentimes PHARMACOLOGY is the most dreaded part of a nursing nursing exam. One reason could be that it requires you to memorize facts, and more often than not, it is difficult to decide on WHAT TO MEMORIZE. But not anymore, the CHECK PRINCIPLE provides you with a framework. It stands for…

C – heck why the medication is given and know the classification of the drug . In other words, you should know the purpose why the medication is given. H –ow will you know if the medication is effective. effective. What are your assessment parameters in monitoring the effects of the drug? E – xactly what time should the medication be given. Some drugs are best taken with meals, some after meals and some, on an empty stomach. Other drugs may also be taken without regard to meals. You should know all of these! C – lient teaching tips. What would you tell your patient to expect. You should be able to give instructions related to the therapeutic and side effects of the drug. 100


K – eys to giving it safely. safely. You sho should be able to identif tify interventions to counteract the adverse/side effects of the drug. So now, now, if you’ you’re re read ready y let’ let’s s CHECK the most most common commonly ly asked drugs in the actual exam…

A Aldomet (Methyldopa) C – Antihypertensive H – Decreased BP E – Take the drug regularly exactly as prescribed C – Impotence can be expected K – Check the BP, BP, the drug may cause hypotension Sample Sample question: question: In a hype hyperte rtens nsiv ive e male male pati patien entt who who is taki taking ng methyldopa (Aldomet) as a maintenance medication, the t he nurse would most likely anticipate the patient to t o complain of: a. photosensitivity b. impotence

c. urticaria d. tarry stool Answer: (B)

Aminophylline (Theophylline) (Theophylline) C – Bronchodilator of breathing H – Ease of breathing E – Best taken in the morning morning on an empty stomach, stomach, because the drug causes insomnia C – Stop smoking as it interferes with the drugs’ effectiveness K – Check the heart rate, the drug may cause tachycardia Maintain adequate urine output Avoid caffeine containing foods Sample question: A nurse should should assess a patient who is receiving receiving aminophyll ylline for for which of the the following side effe ffects of the medication? 101


a. bradycardia b. tachycardia

c. tinnitus d. ecchymosis Answer: (B)

Amphogel (Aluminum Hydroxide Hydroxide gel) C – Antacid; Antacid; it neutralizes or reduces or reduces gastric acidity H – Decreased phosphate level E – Best taken between meals and at bedtime C – The drug may cause constipation K – Administer the drug with a glass of water Report black tarry stool. Monitor for signs and symptoms of hypophosphatemia. Sample question: An adult has been taking aluminum hydroxide (Amphogel) for hyperphosphatemia. It is most important for the nurse to teach the patient: a. b. c. d.

to info inform rm the the physic physician ian if he he has has cons constip tipati ation on the tabl tablets ets tend tend to be be more more effect effective ive than than the the liqui liquid d to repor reportt signs signs of muscle muscle weakne weakness, ss, anore anorexia xia,, and malais malaise e to take large amount of water to ensure passage of the medication to the stomach Answer: (C)

Antabuse (Disulfiram) C – Antialcoholic agent; causes an unpleasant reaction when combined with alcohol H – Patient avoids alcohol E – Best taken after abstaining after abstaining from alcohol for 12 hours C – Instruct the patient to avoid alcohol based substances like: M - OUTH WASH O - VER THE COUNTER COLD REMEDIES F - RUIT FLAVORED EXTRACTS F - OOD SAUCES MADE UP OF WINE A - FTER SHAVE LOTION V - INEGAR 102


S - KIN PRODUCTS K – Inspect the patient’s belongings and confiscate alcohol based substances Monitor liver function tests Sample question: Which of the following statements, if made by a patient who is addicted to alcohol, would indicate an adequate understanding of disulfiram (Antabuse) ? a. b. c. d.

“I will read the labels on mouthwash before using it.” “I need to take this medication on an empty stomach.” “This medication will decrease my desire for alcohol.” “I need to take precautions in the sun.” Answer: (A)

Apresoline ( Hydralazine) C – Antihypertensive H – Decreased blood pressure E – Best taken with food C – Rise slowly from a lying or sitting position K – Monitor for signs and symptoms of orthostatic hypotension Monitor the heart rate for tachycardia Sample question: Prior to the administration of hydralazine (Apresoline) the nurse would evaluate for which of the following? a. b. c. d.

A decrease in the pulse pressure Pulse rate in excess of 110. A significant decrease in blood pressure Presence of confusion and disorientation. Answer: (C)

Artane (Trihexyphenidyl HCL) C –

Anti-parkinsonian; given with pseudoparkinsonism Ex. Amantadine Symmetrel - dopaminergic agent 103

antipsychotics

to

prevent


increases dopamine levels Trihexyphenidyl (Artane) Bipeviden HCl (Akineton) Benztropine Mesylate (Cogentin) - Anticholinergics  decreases acetylcholine H – Muscles become less stiff; decreased pill-rolling tremors E – Best taken after meals C – Avoid driving, the drug causes blurred vision K – Check the BP, the drug may cause hypotension

-

Sample question: The nurse monitors the therapeutic effectiveness of trihexyphenidyl hydrochloride (Artane) in the treatment of parkinson’s disease by evaluating for a decrease in: a. bradykinesia b. occulogyric crisis

c. tremors d. propulsive gait Answer: (C)

ASA (Aspirin) C – Anti-inflammatory; reduces inflammation Ex. Acetylsalicylic acid (Aspirin) Ibuprofen (Motrin, Advil) Indomethacin (Indocin) H – (-) Fever, Inflammation, Pain E – Best taken on full stomach C – Tinnitus indicates toxicity Avoid other over-the-counter cold remedy K – Assess the patient for bleeding tendencies Induce vomiting if overdose occurs Sample question: A patient is taking acetylsalicylic acid (Aspirin) four times daily. To minimize possible complications of this therapy, the nurse should give the patient which of these instructions? a. b. c. d.

“Avoid taking the aspirin with dairy products.” “Drink a glass of water with the aspirin.” “Aspirin should be taken one hour before meals.” “Take the aspirin with food.” 104


Answer: (D) Atropine Sulfate C – Anticholinergic; reduces salivation, reverse heartblocks Ex. Atropine sulfate (Isopto atropine) Propantheline bromide (Pro-Banthine) H – It increases heart rate in a patient with heartblock E – Best taken 30 minutes before meals C - The drug may cause facial flushing Avoid tasks that require acute vision Avoid hot environment K – Check the BP, the drug causes hypotension, constipation and drymouth Sample question: Preoperatively, a patient is given atropine sulfate. Which of these findings would indicate that the desired effects of the medication have been achieved? a. increase in heart rate b. dryness of the lips

c. onset of drowsiness d. relief of nausea Answer: (B)

B

C

Ca Edta (Edetate Calcium Disodium) C – Antidote in lead poisoning H – Increased urinary excretion of lead E – No specific C – Report pain at injection site K – Monitor BUN levels, can damage the kidneys Keep the patient supine

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Sample question: The side effect which is attributed to both the lead toxicity and the primary chelating agent, Ca Edta, is: a. b. c. d.

hypocalcemia bone-marrow depression increased intracranial pressure nephrotoxicity Answer: (D)

Cephulac (Lactulose) C – Laxative; ammonia reduction agent H – Decreased serum ammonia E – No specific C – Report diarrhea K – Monitor serum ammonia levels Administer with juice to disguise the taste Sample question: Lactulose (Cephulac) is ordered for a patient with liver cirrhosis. What is the purpose of this drug? a. b. c. d.

to stimulate secretion of renin to improve glucose utilization to limit excretion of sodium to decrease ammonia absorption Answer: (D)

C – Oral anticoagulants; depresses the synthesis of vitamin K dependent clotting factors Ex. Warfarin sodium (Coumadin) Dicumarol (Bishydroxycoumarin) H – (-) Thrombus E – No specific C – Avoid green leafy vegetables as the Vitamin K content of these vegetables interfere with the absorption of the drug. Avoid contact sports K – Assess for any sign of bleeding Keep vitamin K at the bedside Do not give patient any IM injection 106


Many factors (diet, fever, environment) may change the body’s response to the drug Sample question: A nurse has given patient instructions about taking warfarin sodium (Coumadin). Which of the following statements, if made by the patient, indicates that the patient understands the instructions? a. “I can expect to gain weight while taking this medication.” b. “I will take my pulse prior to each dose.” c. “I can take Aspirin when I have a headache.” d. “I will take the medication at the same time every day.” Answer: (D)

D Demerol (Meperidine HCL) C – Narcotic Analgesic; used to relieve pain of nephrolithiasis H – (-) Pain E – No specific C – Avoid activities that requires alertness Avoid alcohol It may cause facial flushing K – Keep the antidote, naloxone HCL at the bedside Sample question: For the first two days following thoracic surgery, a patient received meperidine hydrochloride (Demerol) every three hours. On the third day, three hours after receiving the Demerol, the patient refuses to cough because of pain in the operative area and feeling nervous. The patient’s respirations are shallow. Based on the above data, which of these actions should the nurse take? a. delay giving the medication to prevent the patient from becoming addicted to the narcotic b. delay giving the medication to avoid further depressing the patient’s respiration c. administer the medication to facilitate the patient’s respiratory exercises 107


d. administer the medication to relieve the patient’s tension Answer: (C)

C – Hypoglycemic agents; stimulate the pancreas to secrete insulin Ex. Chlorpropamide (Diabinase) Tolbutamide (Orinase) Tolazamide (Tolinase) H – Blood sugar level within normal range E – Best given in the morning with food, so sleep will not be disturbed by increased urination C – Take weight daily Protect the skin from exposure to the sun K – Assess for signs and symptoms of hypoglycemia like drowsiness, diaphoresis, and dizziness. Sample question: Diabinase is most effective in which type of diabetes? a. b. c. d.

insulin dependent diabetes mellitus non-insulin dependent diabetes mellitus gestational diabetes diabetic ketoacidosis Answer: (B)

C – Carbonic anhydrase inhibitors; promotes sodium excretion Ex. Acetazolamide (Diamox) H – Increased urine output, decreased vertigo in meniere’s disease E – Best taken in the morning with meals C – Avoid driving Avoid exposure to sunlight K – Assess for unusual bleeding Sample question: A patient with meniere’s disease is prescribed with Diamox. What observation shows that the drug is taking effect? a. increased urinary output b. patient is relieved of constipation c. patient has clearer vision 108


d. vertigo is significantly lessened Answer: (D) Digoxin (Lanoxin) C – Cardiac Glycoside; increases myocardial contraction, decreases heart rate; stones conduction through the AV node Ex. Digoxin (Lanoxin) Deslanoxide (Cedilanid) H – Normal heart rate in patient with atrial fibrillation E – No specific C – Report greenish vision, sign of toxicity Take pulse everyday K – Assess the patients’ heartrate, it causes bradycardia Assess for signs of toxicity (Nausea, Anorexia, Vomiting, Diarrhea) Monitor serum K level. Sample question: A patient who is receiving a digitalis preparation should be observed for symptoms of toxicity, which include: a. hypertension b. oliguria

c. tinnitus d. vomiting Answer: (D)

Dilantin (Phenytoin) C – Anti-convulsants; decreases spread of the seizure process Ex. Phenytoin (Dilantin) H – (-) Seizure E – Best taken with food to enhance absorption C – Massage the gums, it causes gingival hypertrophy May turn the urine pink, red or reddish brown K – Monitor for signs and symptoms of bone marrow depression Do not discontinue abruptly Use saline flush before and after IV administration Report skin rash 109


Sample question: Margaret Tempo is a 7-year-old who has been on phenytoin (Dilantin) and phenobarbital for control of chronic recurrent seizures. In the physical exam, the nurse notes that Margaret has hyperplasia of the gums which is: a. b. c. d.

a common occurrence with chronic recurrent seizures a common side effect of phenytoin (Dilantin) not related to the drug or the disease an unusual side effect of phenobarbital Answer: (B)

Diuril (Chlorothiazide) C – Diuretic H – Increased urine output E – Best taken with food early in the day, so sleep will not be disrupted by increased urination C – Protect the skin from exposure to the sun Muscle weakness in the lower extremities indicate hypokalemia Increase K in the diet K – Monitor weight Sample question: Mr. Backster should be instructed about the side effects of diuril which include: a. insomnia

b. dysuria

c. diplopia

d. weakness Answer: (D)

E

Elavil (Amitriptyline) C – Tricyclic anti-depressant; prevents the reuptake of norepinephrine H – Increased appetite; adequate sleep E – Best given after meals 110


C – Therapeutic effects may become evident only after 2-3 weeks of intake K – Check the BP, it causes hypotension Check the heartrate, it causes cardiac arrythmias Sample question: A community mental health nurse is caring for an elderly homebound patient who has a diagnosis of major depression. Which of the following observations would be typical of a patient who received amitriptyline hydrochloride (Elavil) for a week? a. elevated mood b. increased social activity

c. improved hygiene d. improved sleep pattern Answer: (D)

F Ferrous SO4 C – Iron preparation; used in the prevention and treatment of iron deficiency anemia H – (-) Pallor E – Best taken on an empty stomach C – Avoid milk, egg, coffee and tea, these decrease absorption Take the drug with orange juice to promote absorption K – Keep the antidote, deferoxamine mesylate, at the bedside Sample question: How should a patient take ferrous sulfate? a. b. c. d.

before taking the morning coffee on an empty stomach with citrus juice after meals Answer: (C)

G Garamycin (Gentamicin) C – inhibits protein synthesis; bacteriostatic and bactericidal 111


Ex.

Gentamicin (Garamycin) Tobramycin (Nebcin) Streptomycin H – (-) Infection E – No specific C – Increase fluid intake Tinnitus indicates ototoxicity K – Monitor for signs and symptoms of ototoxicity, nephrotoxicity and neurotoxicity. Sample question: Nelson Hall is a 5-years-old in a pediatric intensive care unit. He has a diagnosis of otitis media, dehydration, and tonsillitis. Nelson is receiving gentamicin via intravenous piggyback every 8 hours. Which of the following statements by Nelson’s mother should alert the nurse to a potential problem? a. “He seems to be hungry today, always asking for ice cream.” b. “He still has some pain, but the shots seem to help” c. “Sometimes he takes a nap and doesn’t want to play.” d. “Nelson is ignoring me. He did not look up when I called him.” Answer: (D)

H Haldol (Haloperidol) C – Antipsychotics; blocks dopamine receptor sites Ex. Haloperidol (Haldol) Chlorpromazine (Thorazine) Fluphenazine (Prolixin) H – Decreased delusions, hallucinations, looseness of association E – Best taken after meals C – Avoid exposure to sunlight K – Monitor BP, it causes hypotension The long acting type (Haloperidol Decanoate) is given once a month

112


Sample question: After administering an injection of Haloperidol Decanoate (Haldol) to a patient, the nurse should instruct the patient to: a. b. c. d.

stay recumbent for four hours avoid foods containing tyramine return for the next injection in four weeks decrease salt intake Answer: (C)

C – Parenteral anticoagulants; prevents conversion of prothrombin to thrombin Ex. Heparin Sodium H – Prolonged PTT E – No specific C – Report signs and symptoms of bleeding K – Monitor the patient partial thromboplastin time Keep protamine SO4 (antidote) at the bedside Do not give by IM injection Sample question: A nurse should expect a patient who has a deep vein thrombosis to be given Heparin sodium (Heparin) to a. dissolve the thrombus b. decrease the pain

c. prevent clot enlargement d. reduce tissue edema Answer: (C)

I

Inderal (Propanolol Hydrochloride) C – Antianginal, Antiarrythmic, Antihypertensive; reduces portal pressure and decreases the risk of bleeding from esophageal varices H – Decreased BP E – Best taken with meals C – Avoid driving; do not discontinue abruptly K – Check the BP, it may cause hypotension 113


Sample question: A nurse should expect a patient who has been diagnosed with hyperthyroidism to be prescribed propanolol (Inderal) in order to: a. b. c. d.

inhibit the synthesis of thyroid hormone increase the effect of calcium on cardiac tissue enhance TSH secretion from the pituitary gland slow the sympathetic nervous system response Answer: (D)

INH (Isoniazid) C – Antitubercular agents, inhibits mycolic acid thus causing a tuberculostatic or tuberculocidal effect Ex. Isoniazid (INH) Rifampicin (Rifadin) Streptomycin H – (-) Infection E – Best taken on an empty stomach C – Report tingling sensation in the lower extremities, it indicates peripheral neuropathy Avoid alcohol K – Liver function studies should be done before the start of therapy Therapeutic effects generally occur in 2 – 3 weeks. Administer with Vitamin B6 to prevent peripheral neuropathy. Sample question: Mrs. Silvia is prescribed isoniazid (INH) for treatment of tuberculosis. The nurse should instruct Mrs. Silvia on which of the following? a. decreased niacin b. increased folate stores

c. increased niacin stores d. decreased in vitamin A Answer: (A)

C – Parenteral hypoglycemic agents; aids glucose across the cell Ex. 1. Rapid acting: 114


Regular Semilente 2. Intermediate acting: NPH Lente 3. Long acting Ultra Lente H – Normal blood sugar level E – Best given before breakfast C – Report signs and symptoms of hypoglycemia (tremors, nervousness) K – Serve meals on time to prevent hypoglycemia When mixing these types of insulin, inject air into the NPH insulin first before the regular insulin, but aspirate the regular insulin first before the NPH insulin Sample question: A patient who is receiving total parenteral nutrition has an elevated blood glucose level and is to be administered intravenous insulin. Which of the following types of insulin should a nurse have available? a. b. c. d.

Isophane insulin (NPH) Regular insulin (Humulin R) Insulin zinc suspension (Lente) Semi-lente insulin (Semitard) Answer: (B)

K

L C – Loop diuretic; blocks the reabsorption of sodium in the loop of Henle Ex. Furosemide (Lasix) Remember: Lasix – it’s a loop diuretic which acts on the ascending loop H – Increased urine output E – Best given in the morning 115


C – Eat bananas and citrus fruits because they are good sources of potassium K – Monitor serum potassium levels, it can cause hypokalemia Sample question: A patient in renal failure is being treated with furosemide (Lasix) via a continuous IV infusion. The nurse knows that the dosage of furosemide (Lasix) to be delivered should not exceed: a. 10 mg/min b. 4 mg/min

c. 4 mg/kg d. 100mg/day Answer: (B)

Lithium Carbonate C – Antimanic H – Decreased hyperactivity E – Best taken after meals C – Increase fluid intake (3 L /day) and sodium intake (3 gm./day) Avoid activities that increase perspiration K – It takes 10-14 days before therapeutic effect becomes evident. Antipsychotic is administered during the first two weeks to manage the acute symptoms of mania until lithium takes effect Monitor serum level, normal is .5-1.5 meq/L. Nausea, Anorexia, Vomiting, Diarrhea and Abdominal cramps indicates lithium toxicity Mannitol is administered if toxicity occurs Sample question: A nurse is caring for a patient who is receiving Lithium carbonate (Eskalith). Prior to administration of the next dose, the nurse finds that the patient’s lithium blood level is 1.6 mEq/L. Which of the following actions should the nurse take first? a. call the patient’s physician b. withhold the dose c.take the patient’s vital signs d. repeat the blood lithium level Answer: (B)

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M Magnesium SO4 C – Anticonvulsant H – (-) Convulsion E – No specific C – Diarrhea is a side effect K – Keep the antidote, calcium gluconate at the bedside Assess the patient’s respiratory rate, (should be at least 12/min.) deep tendon reflex and urine output, (should be at least 30 ml./hr.) Sample question: During labor a woman is receiving magnesium sulfate intravenously. It is essential that a nurse have which of the following drugs available to counteract potential adverse effects? a. Oxytocin (Pitocin) b. Sodium bicarbonate

c. Phenytoin sodium (Dilantin) d. Calcium gluconate Answer: (D)

C – Osmotics; decreases water reabsorption Ex. Mannitol (Osmitrol) H – Increased urine output E – Best given in the morning C – Avoid alcohol and prolonged exposure to sunlight K – Monitor BP and serum potassium Sample question: A patient with a closed head injury is started on IV mannitol to decrease intracranial pressure. If the patient complains of headache or becomes confused several hours after the drug is administered, the nurse should assess the patient for which of the following? a. b. c. d.

elevated atrial blood pressure elevated serum electrolytes elevated intracranial pressure elevated central venous pressure 117


Answer: (C) Mestinon (Pyridostigmine) C –Cholinesterase inhibitor ; used as treatment for myasthenia gravis H – Increased muscle strength E – Usually administered before meals C – Report the development of rash, the drug may increase peristalsis K – Monitor for muscle weakness Keep the antidote, atropine SO4 at the bedside Sample question: A diagnosis of myasthenia gravis is confirmed, and Ms. Gaddi is started on pyridostigmine (Mestinon) orally. The nurse will be alert for which of the following adverse effect of Mestinon? a. constipation b. urinary retention

c. diarrhea d. dry mouth Answer: (C)

Methergin (Methylergonovine Maleate) C – Oxytocic; used as a treatment for postpartum atony and hemorrhage H – Firmly contracted uterus E – No specific C – Report difficulty of breathing K – Monitor the BP, it causes hypertension Sample question: A potential side effect of Methergin is: a. hypotension b. hypertension

c. hypokalemia d. hyperphosphatemia Answer: (B)

Monoamine Oxidase Inhibitor (MAOI) 118


C – Antidepressant H – Increased appetite; adequate sleep E – Best taken after meals C – Report headache; it indicates hypertensive crisis Avoid tyramine containing foods like: A-vocado B-anana C-heddar and aged cheese S-oysauce and preserved foods K – Monitor the BP Sample question: Which of the following foods, if chosen by a patient who is taking a monoamine oxidase inhibitor (MAOI), indicates that the patient is following the prescribed diet? a. Prunes b. Aged cheese

c. Fresh vegetables d. Sausage Answer: (C)

Morphine SO4 C – Narcotic Agonist, Analgesic; given to decrease anxiety in a patient with pulmonary edema; promotes venous pooling of blood in the periphery, so it decreases venous return to the heart H – Relief of pain E – Best taken with food C – Avoid driving, Report severe nausea and vomiting K – Keep Naloxone HCL (antidote) at the bedside Instruct the patient to lie down during IV administration. Morphine causes more pain in pancreatitis because it increases the spasm of the sphincter of oddi, so avoid giving it. Sample question: A nurse should be aware that morphine sulfate is administered to a patient who has pulmonary edema in order to: a. diminish venous return to the heart b. decrease pain 119


c. decrease the respiratory rate d. reduce the glomerular rate Answer: (A)

N

Nitroglycerin C – Antianginals; decreases oxygen demand, decreases preload by dilating veins Ex. Nitroglycerin (Nitrobid, Tridil, Transderm, Deponit) H – Relief of chest pain E – Best taken before any strenous activity C – Place a tablet under the tongue at the first sign of chest pain “Burning sensation” under the tongue is a sign of potency of the drug. Facial flushing is a side effect. Do not chew the tablet. Keep the tablets in a dark container. K – Monitor the BP and heart rate Sample question: Which of these statements, if made by a patient who has a prescription for sublingual nitroglycerin tablets, would indicate a correct understanding of the medication instructions? a. b. c. d.

“I should take these pills with a full glass of water.” “I should protect these pills from light.” “I should wait 30 minutes before taking the second pill.” “I should chew the pill for a faster effect.” Answer: (B)

O P

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Penicillin C – interferes with division of bacteria Ex. Penicillin Methicillin Amoxicilin H – (-) Infection E – Best taken on an empty stomach with a full glass of water C – Report the development of rash K – Keep the antidote, epinephrine at the bedside Sample question: A child who is being treated for rheumatic fever is given instructions about her penicillin therapy. The child’s parents ask the nurse, “What is the purpose of our child being on penicillin for an indefinite time?” the nurse should respond that the purpose of the penicillin regimen is to: a. b. c. d.

stimulate the immune system prevent a recurrence of the disease alter the flora in the respiratory tract prevent permanent pathologic changes in the joints Answer: (B)

Phenergan ( Promethazine Hydrochloride) C – Antihistamine H – (-) Allergy E – No specific C – Avoid alcohol and prolonged exposure to sunlight K – Do not administer SC, tissue necrosis may occur Sample question: A patient is scheduled for surgery and is to receive promethazine hydrochloride (Phenergan) 35 mg intramuscularly. The drug is available in ampules containing 50 mg./ 1 ml of solution. The patient should receive how many milliliters of solution? a. 0.3

b. 0.7

c. 1.0 121

d. 1.4


Answer: (B)

Pitocin (Oxytocin) C – Oxytocic; used to induce labor after artificial rupture of the membranes H – Firmly contracted uterus E – No specific C – Report the development of rash K – Monitor the BP Discontinue if hypertension develops Sample question: Because a woman is receiving oxytocin (Pitocin) for induction of labor, it is essential for the nurse to monitor: a. fundal height b. patellar reflexes

c. cervical changes d. level of consciousness Answer: (C)

Probenecid (Benemid) C – Antigout Ex.

Colchicine (Novocolchine) - control inflammation of the attack Probenecid (Benemid) - increases excretion of uric acid Allopurinol (Zyloprim) - decreases production of uric acid H – Decreased uric acid levels E – Best taken with meals C – Change position slowly K – Increase fluid intake Sample question: Mr. Ray states that he is taking a medication for gout but cannot remember the name. He states that it is especially important that he drinks eight glasses of water daily to keep the excreted uric acid dilute. This drug is contraindicated in patients with renal failure or with a history of renal stones. Which drug is Mr. Ray most probably taking? 122


a. Probenecid b. Allopurinol

c. Colchicine d. Tylenol Answer: (A)

Prostigmin (Neostigmine) C – Anticholinesterase; increases muscle strength by inhibiting acetylcholinesterase Ex. Endrophonuim chloride (Tensilon) Neostigmine methylsulfate (Prostigmin) Pyridostigmine bromide (Regonol) H – Increased muscle strength E – No specific C – Report diarrhea, abdominal pain and muscle weakness Avoid hot and excessively humid environment K – Keep the antidote, pralidoxime chloride (PAM) or atropine at the bedside Sample question: In a patient receiving prostigmin (Neostigmine) for treatment of Myasthenia Gravis, the nurse should plan to have which of the following drugs at the bedside ? a. lidocaine b. epinephrine

c. atropine d. procainamide Answer: (C)

PTU (Propylthiouracil) C – Antithyroid; inhibits synthesis of thyroid hormone H – Decreased heart rate; adequate sleep E – Take the drug around the clock at 8 hour interval C – Treatment is lifelong Report the development of sorethroat, it indicates agranulocytosis K – Monitor the heart rate, it causes tachycardia contraindicated in pregnant patients 123


Sample question: A patient with hyperthyroidism is started on propylthiouracil (PTU). When should the nurse expect noticeable improvement in the patients’ condition? a. in 24 to 48 hrs c. in 2 to 4 weeks b. in 6 to 7 days d. in 6 months Answer: (C)

R

RhoGAM (Rho Immune Globulin) C – Prevents sensitization to the Rho factor H – (-) Erythroblastosis Fetalis E – Administer within 72 hours after Rh incompatible delivery C – Report pain and soreness at injection site K – Given to Rh (-) mother with an Rh (+), Coombs (-) Baby Sample question: An Rh – negative mother would need to receive Rho (D) immune –globulin (RhoGAM) within 72 hours after delivery if her newborn had which of the following blood test results? a. b. c. d.

Rh negative, Coombs positive Rh negative, Coombs negative Rh positive, Coombs negative Rh positive, Coombs positive Answer: (C)

C –

Stimulants; increases attention span thus decreasing hyperactivity Ex. Methylphenidate (Ritalin) Amphetamine (Benzedrine) H – Decreased hyperactivity E – Best given after meals because it suppresses the appetite if given before meals; Give it in the morning or at least 6 hours before bedtime since it causes insomnia C – May cause growth retardation K – Monitor growth and development 124


Sample question: Methylphenidate (Ritalin) calms impulsiveness, hyperactivity and restlessness of attention deficit disorder (ADD) or hyperactive children by a paradoxical calming effect. The nurse knows that this means: a. b. c. d.

Ritalin is an anxiolytic and calms the child Ritalin is a stimulant and calms the child Ritalin is an analgesic and calms the child Ritalin is a relaxant and calms the child Answer: (B)

S Streptomycin C – Aminoglycoside; used to destroy the vestibular apparatus to decrease vertigo in a patient with meniere’s disease H – (-) Infection E – Best taken after meals, to decrease GI upset C – Report oliguria, it indicates nephrotoxicity K – Increase fluids Monitor BP and pulse The drug causes ototoxicity, nephrotoxicity and neurotoxicity Sample question: If a patient is receiving Streptomycin, which of the following should the clinic nurse report immediately to the physician? a. drooping of the eyelids b. stoma of the mouth

c. inflammation of the joint d. loss of hearing Answer: (D)

Symmetrel (Amantadine) C – Antiparkinsonian, Dopaminergic, Antiviral H – Muscles become less stiff E – No specific 125


C – Report swelling of fingers K – Do not discontinue abruptly Sample question: Amantadine hydrochloride (Symmetrel) is prescribed for a patient with Parkinson’s disease. The patient asks how the drug works. In formulating a response, the nurse recalls that the drug: a. b. c. d.

Allows accumulation of dopamine Corrects mineral deficiencies Elevates the patient’s mood Blocks dopamine receptors Answer: (A)

C – Thyroid agents; replace missing thyroid hormones Ex. Levothyroxine sodium (Synthroid) Thyroglobulin (Proloid) Liotrix (Euthroid) H – Normal T4 levels; in female patients there will be resumption of menstruation E – Best taken in the morning, to prevent insomnia C – Treatment is lifelong K – Monitor BP and pulse Sample question: A female patient is ordered to take Synthroid 0.4 mg daily. She has been taking this medication for 4 days. Which of the following statements would indicate that the nurse should recommend a change in the patient’s medication? a. b. c. d.

develops nervousness and difficulty sleeping states she has “NO ENERGY” and is “just tired” patient has coarse hair and skin has a persistent weight gain Answer: (A)

T Tagamet (Cimetidine) 126


C – Histamine antagonist; inhibits gastric acid secretion H – Relief of symptoms of heartburn, acid indigestion E – Best given with food, when administering it with an antacid, give the antacid one hour before cimetidine C – Avoid smoking, it decreases drug efficacy K – Administer IM dose undiluted deep into large muscle Infusion should be diluted in at least 50 cc of D 5W Sample question: Mr. Ojastro is receiving cimetidine (Tagamet) 300 mg every 6 hours IVPB for a duodenal ulcer. The nurse should administer the medication using which of the following methods? a. undiluted, IV push over 1 minute b. diluted in 20 cc of compatible solution and IV push over 1 minute c. diluted in 50 cc of compatible solution and infused over 15 to 20 minutes d. undiluted and infused over 15 to 20 minutes Answer: (C)

Timolol Maleate (Timoptic) C – Antihypertensives; lowers the blood pressure Ex. Beta adrenergics blockers - decreases cardiac output Atenolol (Tenormin) Timolol (Blocadren) H – Decreased BP; IOP E – No specific C – Avoid driving K – Administer ophthalmic eye drops in the lower conjunctival sac The drug may cause hyperglycemia or hypoglycemia Sample question: A patient is given a prescription for timolol maleate (Timoptic) eyedrops. The nurse should instruct the patient to instill the eyedrops at which of these areas of the eyes? a. in the inner canthus b. on the cornea

c. in the conjunctival sac d. on the center of the pupil

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Answer: (C)

V

C – Antianxiety agents; anxiolytics - depresses the reticular activating system Ex. Diazepam (Valium) Chlordiazepoxide (Librium) Oxazepam (Serax) H – Decreased anxiety, adequate sleep E – Best taken before meals, food in the stomach delays absorption C – Avoid driving, intake of alcohol and caffeine containing foods, since it alters the effect of the drug K - Administer it separately, it is incompatible with any drug Sample question: The nurse is caring for a patient with severe back strain. The nurse administers diazepam (Valium) 10 mg qid. Which observation is most indicative of the need to reassess this order? a. b. c. d.

drowsiness hyperesthesia of the arms loss of appetite severe muscle spasms Answer: (D)

Vitamin K (Phytonadione) C – Antidote, promotes formation of prothrombin, given in neonates to prevent bleeding H – (-) Bleeding E – No specific C – Report the development of rash K – Monitor prothrombin time, to determine dosage effectiveness Sample question: A newborn receives vitamin K (Aquamephyton) to: a. protect the eyes from infection 128


b. prevent bleeding problems c. boost the immune response d. stimulate growth of gastrointestinal flora Answer: (B)

X Xylocaine (Lidocaine) C – Antiarrhythmic, Anesthetic; used to treat premature ventricular contractions H – Normal heart rate E – No specific C – Tinnitus is a side effect K – Monitor BP and serum electrolytes Convulsion is the first sign of toxicity Sample question: The nurse will plan to assess for the following side effects related to intravenous lidocaine therapy: a. disorientation b. photophobia

c. dry mouth d. abdominal cramps Answer: (A)

Y Yutopar (Ritodrine) C – Tocolytic, used to treat pre-term labor by decreasing the intensity and frequency of uterine contractions. H – Relaxed uterus E – No Specific C – Report increase in pulse rate, it causes palpitation 129


K – Contraindicated before 20th week of pregnancy, in patients with hemorrhage, hypertension, infection, bleeding disorders and spontaneous abortion. Sample question: Richelle is admitted to the labor and delivery unit at 22 weeks gestation. She is evaluated for abruptio placenta. The nurse knows that ritodrine HCl (Yutopar) is indicated in this case to prevent labor. Which of the following is not a contraindication for ritodrine HCl? a. b. c. d.

pregnancy induced hypertension chorioamnionitis maternal cardiac disease multiple fetuses Answer: (D)

Z

Zyloprim (Allopurinol) C – Antigout; used to prevent or treat attacks of gout H – Decreased uric acid levels E – Best taken with food C – Instruct the patient to report sore throat, it signals the development of agranulocytosis K – Increase fluid intake to facilitate excretion of uric acid crystals Avoid over the counter medications, most of these contain vitamin C which can increase the likelihood of renal stone formation Sample question: Inez is 9-years-old, and newly diagnosed with leukemia. She is just starting her chemotherapy. The physician also orders Allopurinol for her. This drug has been ordered for Inez to decrease the possibility of: a. infection b. hyperuricemia

c. nausea and vomiting d. bone narrow depression Answer: (B) 130


N.B. To facilitate easier recall the brand names of the drugs were written ahead of the generic names.

Let’s SYNTHESIZE!

After going through that list, I’m sure you would agree with me if I tell you that we can still make things MORE SIMPLE. Let’s start …

Drugs with ANTIDOTE Acetaminophen…………………………………………….Acetylcysteine Benzodiazepine……………………………….……………….Flumazenil Coumadin………………………..……………………………….Vitamin K Curare……………………………………..…...Endrophonium (Tensilon) Cyanide poisoning………..…….……………..………....Methylene blue Digitalis…………………………..……….……..…………………Digibind Ethylene poisoning………………………..…….…..Fomepizol (Antizol) Heparin……………………………...…..……….…….Protamine Sulfate Iron………………………………..….Deferoxamine Mesylate (Desferal) Lead……………………………….…...…...…Edetate Disodium (EDTA) Dimercaprol (BAL) Succimer (CHEMET) Lovenox..………………………………………….………Protamine SO4 Magnesium sulfate………………….……………….Calcium Gluconate Morphine sulfate………………..……………...Naloxone Hydrochloride Methotrexate……………………………………………....….Leucovorine Mestinon…………………………………………………..Atropine Sulfate Neostigmine……………...…………………Pralidoxime Chloride (PAM) Penicillin…………………………...…………………………..Epinephrine 131


Drugs which are BEST TAKEN WITH MEALS Allopurinol Apresoline ASA Azulfidine Benemid Dilantin Diuril

Flagyl Inderal Morphine Pancreatin Serpasil Tagamet Tylenol

Drugs which are BEST TAKEN BEFORE MEALS Atropine Sulfate Bactrim

Dalmane Insulin

Mestinon Valium

Drugs which are BEST TAKEN AFTER MEALS Artane Cogentin Clozaril Deltasone Elavil

Haldol Lithium MAOI Nardil Pyridium

Ritalin Streptomycin Thorazine Tofranil

Drugs which are BEST TAKEN ON AN EMPTY STOMACH Ampicin Chloromycetin Erythrocin

Ferrous Sulfate INH Isordil

Penicillin Rifadin

Drugs which need to be taken in the MORNING Accutane Adriamycin Aminophylline Cytoxan

Diabinase Diamox Epinephrine Mannitol

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Sudafed Synthroid Tamofen Theodur


Drugs which can be taken WITHOUT regard to MEALS Ancef Demerol AZT Dexasone Ca EDTA Gentamicin Cardiazem Heparin Cefoxitin Na Methergin Cephulac Neomycin Sulfate Codeine Nipride Coumadin Oncovin

Phenergan Pitocin Povan Prostigmine Robaxin Rocephin Sulfamylon Symmetrel

Drugs which can cause URINE DISCOLORATION Adriamycin……..……………………………………….Reddish Bactrim………………………………………………Red Orange Dilantin…………………………………………..……Pink tinged Flagyl…………………………………………………..Brownish Azulfidine…………………………………………Orange Yellow Rifabutin………………………………………………Red Orange Rifampicin………………………………………….Red Orange Robaxin………………………………Brown, Black or Greenish

Drugs which should be TAKEN FOR THE REST OF THE PATIENTS’ LIFE Anticholinesterase (MESTINON)…………………..Myasthenia Gravis Antithyroid drugs (PTU)………………………………..Hyperthyroidism Aspirin………………………………………………………….…..Arthritis AZT ……………………………………………………………..…… AIDS Dopaminergic agents (L-DOPA)………………….Parkinsons’ Disease Glucocorticoids (DELTASONE)…………….. ……..Addisons’ Disease Glucocorticoid synthesis inhibitors (Mitotane) …... Cushing’s disease Insulin (NPH,REGULAR)…………….…………….… Diabetes Mellitus Miotics(PILOCARPINE)………………………………….……Glaucoma Penicillin……………………………………....Rheumatic Heart Disease Thyroid Supplement ( SYNTHROID)………….……….Hypothyroidism Vitamin B 12…………………………………………..Pernicious Anemia 133

Part 5 Drugs

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