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PHARMACOLOGY Pharmacology - most simply defined as study of drug. Fundamentals of Pharmacology 1. Pharmacokinetics - study of drugs changes as it enters and passes through the body. a. absorption b. distribution c. biotransformation d. excretion 2. Pharmacodynamics - mechanism by which drugs produce changes in body tissue. a. desired effect - intended action of drugs b. adverse effect - harmful unintended reactions c. side effects conse uence reactions d. toxicity the degree which something is poisonous digoxin ! ".# 2." ng$m% lithium ! ".# 1.# m& $% Safety and Efficacy ursing Princi!les " 1. 'lways verify the Fi#e Rights . a. the right medications b. the right client c. the right dosage d. the right form( route and techni ue e. the right time 2. )hart drug administration only after its been given( never before. *. +ever leave the medication on cart or tray unattended. ,. )hart observed therapeutic and adverse effects accurately and fully. #. )heck history for allergies and potential drug interactions before administering a newly ordered drug. -. .nform the prescribing physician of any observed adverse effects/ if cannot be located( inform the nursing supervisor 0. 1uestion drug orders that are unclear( that appear to contain errors( or that have potential to harm. 2. 3ake the following actions if an error occurs 4 a. immediately notify the nursing supervisor( the prescribing physician( and the pharmacist. b. assess the clients condition and provide any necessary care. 5. 6or postpartum women( advice to take drugs after breastfeeding. Administration of $rugs " Routes and ursing considerations" 1. &nteral oral( sublingual( rectal( gastric tubes - capsulated pill( sustained release and enteric coated should not be crushed. 2. Parenteral .7( .8( 91( .:( .3( .'( epidural. - vastus lateralis ;safest site for .8< *. 3opical skin( inhalants( mucus membrane. Eye medications " - administer eyedrops first then ointment. - use a separate bottle for each client. - instruct the client to tilt the head backward( open eyes and look up. - avoid contact of medication bottle to the eyeball. - place prescribed dose in the lower con=unctival sac. - instruct the client to press the inner canthus for *"--" seconds. - instruct the client to close the eye gently. Ear dro!s - in infant and children younger than * y.o( pull pinna downward and backward. - in older children and adult( upward and backward. - direct the solution on the wall of the ear canal( not directly on the ear drum. CLASS%F%CA&%O S OF $R'GS $R'GS AFFEC&% G &HE CE &RAL A $ A'&O OM%C SYS&EM Cholinergic Agents ;Parasympathomemitics< Prototy!e " - synthetic acetylcholine( pilocarpine( carbachol( bethanecol ;>rocholine<( edrophonium ;3ensilon<( neostigmine ;Prostigmine<( pyridostigmine ;8estinon<. Mechanism of action "

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- stimulates cholinergic receptors by mimicking acetylcholine or inhibition of en?yme cholinesterase. %ndications " - glaucoma( urine retention( 8yasthenia @ravis - antidote to neuromuscular blocking agents 4 tricyclic antidepressants and atropine Ad#erse effects " - blurring of vision( miosis - increase in salivation( intestinal cramps - bronchoconstriction( whee?ing( :AB - hypotension and bradycardia ursing considerations " 1. Carn D monitor clients of the side effects. 2. Eave atropine available for use as antidote. Cholinergic (loc)ing Agents *Parasym!atholytics+ Anticholinergics, Prototy!e " - atropine( scopalamine ;3riptone<( dicyclomine ;Bentyl<( propantheline ;Pro-Banthine<. Mechanism of actions " - block the binding of acetylcholine in the receptors of parasympathetic nerves. %ndications " - use preoperatively to dry up secretions. - treat spasticity of @. or urinary tract. - use for treatment of bradycardia( asthma( parkinsonism. - use for antidote in organophosphate poisoning. Ad#erse effects " - dry mouth ( dilatation of pupils( tachycardia - urinary retention( ileus( heat stroke ursing considerations " 1. Feep clients in cool environment. 2. Catch out for signs of heatstroke and dehydration. *. &ncourage clients to increase fluid intake and use of sugarless gum$candy for dry mouth. ,. 6or @. spasticity( administer *" minutes before meals and at bed time. Adrenergic Agents ;9ympathomimetics< Prototy!e " - epinephrine( norepinephrine( ephedrine( dopamine( dobutamine( phenylephrine( terbutaline( albuterol( isoproterenol. Mechanism of actions " - stimulate alpha and beta adrenergic receptor directly or trigger the release of catecholamines indirectly causing sympathetic effects. %ndications " - cardiopulmonary arrest( hypotension - )AP: and asthma( nasal congestions - allergic reaction( anaphylactic shock Ad#erse effects " - restlessness( insomnia( tremors( nausea - palpitations( angina( tachycardia( EP+ ursing considerations " 1. )ontraindicated in clients w$ hyperthyroidism( pheochromocytoma D cardiovascular disease. 2. 8onitor vital signs and advice precautions. *. 9hould be taken with food. A$RE ERG%C (LOC-% G AGE &S Prototy!e " a. 'lpha blockers - phentolamine ;Gegintine<( phenoxyben?amine( pra?osin ;8inipress<( reserpine ;9erpasil<( tera?osin ;Eytrin< - clonidine ;)atapress<( methyldopa ;'ldomet< b. Beta blockers - atenolol ;3enormin<( esmolol ;Brevibloc<( metoprolol ;%opressor<( nadolol ;)orgard<( propanolol ;.nderal<( timolol ; Blocadren< Mechanism of actions " a. alpha blockers - inhibits action of a-receptors in vascular smooth muscle to cause vasodilatation. b. beta blockers - compete with epinephrine in b-receptors in heart( pulmonary airways( peripheral circulation and )+9. %ndications " - Gaynauds disease( hypertension( pheochromocytoma. - angina( arrhythmias( mitral valve prolapse( glaucoma Ad#erse effects "

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- orthostatic hypotension( bradycardia( )E6 - depression( insomnia and vertigo - bronchospasm and dyspnea( nasal stuffiness( cold extremities ursing considerations " 1. 'dminister oral alpha-blockers with milk to minimi?e @. side effects. 2. 'dminister oral beta-blockers before meals and at a.m. if insomnia occurs. *. )heck clients apical pulse rate before drug administration( refer if below -" bpm. ,. Eypotensive precautions. #. Carn clients not to drive or operate dangerous machinery until he$she has ad=usted to medications. S-ELE&AL M'SCLE RELA.A &S AGE &S Prototy!e " - methacarbamol ;Gobaxin<( baclofen ;%ioresal<( dantrolene ;:antrium<( metaxalone ;9kelaxin<( orphanedrine ;+orgesic<( chlor?oxa?one Mechanism of actions" - depress )+9 - inhibit calcium ion release in the muscle - enhance the inhibitory action of @'B' ;gamma-amino butyric acid< %ndications " - for acute musculoskeletal pain - for muscle spasticity associated with multiple sclerosis( cerebral palsy( )7'( and spinal cord in=ury. Ad#erse effects " - hypotonia( ataxia( hypotension( drowsiness - blurred vision( bradycardia( depression( urine retention ursing considerations " 1. )aution clients that mental alertness may be impaired. 2. 8onitor neuromuscular status( bowel and bladder functions. *. .nform clients that maximum benefit of baclofen is attained for 1-2 months. ,. Geduce baclofen dosage gradually because of associated withdrawal symptoms 4 )onfusion( hallucinations( paranoia D rebound spasticity. A &%CO /'LSA &S Prototy!e " a. Eydantoins - phenytoin ;:ilantin< b. Barbiturates - phenobarbital ; %uminal< c. 8iscellaneous - carbama?epine ;3egretol<( dia?epam( clora?epate ;3ranxene<( valproic acid ;:apakene<( ethosuximide ;Harontin<. Mechanism of action " - treat sei?ures by depressing abnormal neuronal activity in motor cortex. Ad#erse effects " - sedation D drowsiness( gingival hyperplasia - diplopia( nystagmus( vertigo( di??iness - thrombocytopenia( aplastic anemia ursing considerations 4 1. 'dvise female clients to use contraceptives. 2. .nform clients taking phenytoin that harmless urine discoloration is common. *. Carn clients with diabetes that hydantoins may increase blood sugar level and that valproic acid may produce a false positive result in urine ketone test. ,. 3each clients receiving carbama?epine to identify symptoms of bone marrow depressions. #. Geassure that barbiturates are not addictive at a low dosage. -. 'void taking alcohol with barbiturates. 0. 'dminister .7 phenytoin slowly to avoid cardiotoxicity. 2. 'void mixing other drugs in same syringe with phenytoin.

A &%PAR-% SO %A AGE &S Prototy!e " a. 'nticholinergic agents - trihexyphenidyl ;'rtane<( ben?tropine ;)ongentin< b. :opaminergic agents - %evodopa( carbidopa-levodopa ;9inemet<( amantidine ;9ymmetrel<( pergolide ;Permax<( selegiline ;&ldepryl<( bromocriptine. Mechanism of actions " a. anticholinergic agents - inhibit cerebral motor centers.

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b. dopaminergic agents - increasing dopamine concentrations or enhancing neurotransmitter functioning. Ad#erse effects of do!aminergic agents" a. levodopa nausea( vomiting( anorexia( orthostatic hypotension( dark-colored urine and sweat b. amantidine ankle edema( constipation c. bromocriptine palpitations( tachycardia ursing considerations " 1. @ive dopaminergic agents after meals to reduce @. symptoms. 2. Geassure client that levodopa may cause harmless darkening of urine and sweat. *. 'void taking 7it B- ;pyridoxine< with levodopa because it speed up metabolism. ,. &ducate clients to minimi?e orthostatic hypotension. #. &levate leg to reduce ankle edema. CE &RAL ER/O'S SYS&EM S&%M'LA &S Prototy!e " - amphetamines( methylphenidate ;Gitalin< Mechanism of actions " - increase excitatory )+9 neurotransmitter activity and blocks inhibitory impulses. %ndications " - for obesity ;amphetamines< - attention deficit hyperactivity disorders - narcolepsy - drug-induced respiratory depressions. Ad#erse effects " - nervousness( insomnia( restlessness - hypertension( tachycardia( headache - anorexia( dry mouth. ursing considerations " 1. 9hould be given at morning. 2. :ont stop amphetamine abruptly to avoid withdrawal symptoms. *. 8onitor blood pressure and pulse. ,. .ce chips or sugarless gum for dry mouth. #. Catch out for growth retardation in children taking methylphenidate. $R'GS AFFEC&% G ME &AL F' C&%O % G Sedati#es+ Hy!notics+ and An0iolytics Prototy!e " a. Ben?odia?epines - dia?epam ;7alium<( lora?ipam ;'tivan<( alpra?olam ;Ianax<( flura?epam ;:almane< b. Barbiturates - amobarbital( phenobarbital( secobarbital c. 8iscellaneous - chloral hydrate ;+octec<( buspirone ;Buspar<( paraldehyde ;Paral< Mechanism of actions " a. Ben?odia?epines - increase the effect of inhibitory neuro transmitter @'B' ;gamma-amino butyric acid< b. Barbiturates and 8iscellaneous agents - depress )+9 %ndications " - induce sleep( sedate and calm clients Ad#erse effects " - hangover-effect( di??iness( )+9 depression - respiratory depression( drug-dependence ursing considerations " 1. Carn clients of in=uries and falls. 2. Brief period of confusion and excitement upon waking up is common with ben?odia?epines. *. Carn clients not to discontinue medications abruptly without consulting a physician. ,. 'void alcohol while taking these drugs. -. Gotate and dont shake the ampules of barbiturates. :ont mix with other drugs. 0. Carn female clients that dia?epam is associated with cleft lip. A &%$EPRESSA &S A $ MOO$ $%SOR$ER $R'GS Prototy!e " a. 3ricyclic antidepressants - amitriptyline ;&lavil<( protriptyline ;7ivactil<( - imipramine ;3ofranil<( desipramine b. 8'A ;monoamine oxidase inhibitors < - isocarboxa?id ;8arplan<( phenel?ine ;+ardil<( tranylcypromine ;Pernate< c. 9econd-generation antidepressants

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- fluoxetine ;Pro?ac<( tra?odone ;:esyrel< d. %ithium Mechanism of actions " a. 3ricyclic antidepressants - increase receptor sensitivity to serotonin and$or norepinephrine. b. 8'A inhibitors - inhibit the en?yme 8'A that metaboli?e the neurotransmitters norepinephrine and serotonin. c. 9econd generation antidepressants - inhibits the reuptake of serotonin. d. %ithium - increase serotonin D norepinephrine uptake Ad#erse effects " - dry mouth( blurred vision( urine retention( constipation ;anticholinergic effects< - orthostatic hypotension( insomnia - hypertensive crisis ;8'A< - dehydration ;%ithium<. ursing considerations " 1. )aution client to rise slowly to reduce the effects of orthostatic hypotension. 2. 3ake antidepressant with food to enhance absorption *. &xplain to client that full response may take several weeks ;2 weeks<. ,. 'ssess client for constipation resulting from tricyclic antidepressant use. #. )lient taking 8'A inhibitors should avoid tyramine-rich foods to avoid hypertensive crisis. - aged cheese( sour cream( yogurt( beer( wine( chocolate( soy sauce and yeast - pentholamine ;Gegintine< is the drug of choice for hypertensive crisis. -. .nform physician and withhold fluoxetine if client develop rashes. 0. 3ake lithium with food to reduce @. effects - J 1.# m& $% blood level may cause toxicity manifested by4 confusion( lethargy( sei?ures(hyperreflexia. - maintain salt and ade uate fluid intake - tremors may occur but it is temporary - monitor white blood cell count ;increase<. A &%PSYCHO&%C $R'GS * E'ROLEP&%CS, Prototy!e " a. Phenothia?ines - chlorproma?ine ;3hora?ine<( - trifluopera?ine ;9tela?ine<( - thiorida?ine ;8ellaril< b. Ather 'gents - clo?apine ;)lo?aril<( haloperidol ;Ealdol< Mechanism of action " - block dopamine receptor in the limbic system( hypothalamus( and other regions of the brain. Ad#erse effects " - &xtra pyramidal symptoms such as dystonia( pseudoparkinsonism( and an irreversible tardive dyskinesia as manifested by 4 a. lip smacking b. fine wormlike tongue movement c. involuntary movements of arms and leg. - +euroleptic malignant syndrome a. fever( tachycardia( tachypnea( diaphoresis( cardiovascular collapse b. muscle rigidity( sei?ures. - orthostatic hypotension ursing considerations " 1. 3each family members the signs of &P9 and +89( and report to physician immediately. 2. +ormali?ation of symptoms may not occur for several weeks after beginning of therapy . *. 'void administering haloperidol intravenously ,. Catch out of neutropenia with clo?apine. #. Catch out for orthostatic hypotension and photosensitivity with phenothia?ine. -. Be sure that oral doses are swallowed( and not hoarded. $R'GS 'SE$ % PA% MA AGEME &

General Anesthetics Prototy!e " a. .nhalation anesthetics - enflurane ;&thrane<( halothane - isoflurane ;6orane<( nitrous oxide b. .n=ection anesthetics - fentanyl ;9ublima?e<( ketamine ;Fetalar<(

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thiopental +a ;Penthotal<( etomidate ;'midate< Mechanism of actions " - cause )+9 depression( by producing loss of consciousness( unresponsiveness to pain stimuli( and muscle relaxation. ursing considerations " 1. .nstruct client +PA for 2 hours before administration. 2. 8onitor cardio pulmonary depression and hypotension. *. 8onitor urinary retention. ,. 8onitor body temperature - malignant hyperthermic crisis 4 dantrolene ;antidote< #. 'void alcohol or )+9 depressants for 2, hours after anesthesia. -. .n patient who received halothane( monitor signs of hepatic fatal side effects 4 - rash( fever( nausea( vomiting - =aundice and altered liver function. LOCAL A $ &OP%CAL A ES&HE&%C Prototy!e " local 4 bupivacaine( lidocaine( tetracaine( procaine( mepivacaine( prilocaine topical 4 ben?ocaine( butacaine( dibucaine(lignocaine Mechanism of action " - block transmission of impulses across nerve cell membrane. Ad#erse effects " - cardiac dysrhythmias ursing considerations " - lignocaine K prilocaine ;&8%' cream< should be applied topically -" minutes before procedure. - administer cautiously to the areas of large broken skin. - observe for fetal bradycardia in pregnant clients. A ALGES%CS Prototy!e " a. +arcotic analgesics - codeine( meperidine ;:emerol< morphine( butorphanol ;9tadol< nalbuphine ;+ubain< b. +on narcotic analgesic +9'.:s aspirin ;aminosalicylic acid<( mefenamic acid ;Ponstan<( ibuprofen ;8otrin<( naproxen( ketoprofen ;Arudis<( ketorolac. paracetamol and acetaminophen ;3ylenol< Mechanism of actions " a. +arcotic analgesics - alter pain perception by binding to opiod receptors in )+9. b. +on- narcotic analgesic - relieves pain and fever by inhibiting the prostaglandin pathway. ursing considerations " 1. 8onitor respiratory depression D hypotension in clients taking narcotic analgesic. 2. .n=ury and accident precautions in clients taking narcotic analgesic. *. Carn clients about possibility of dependency(and do not discontinue narcotics abruptly in the narcotic-dependent clients. ,. +aloxone is antidote for narcotic overdose. #. 'dvice clients to take +9'.:s with food and monitor bleeding complications. -. 'spirin is contraindicated in clients below 12 years old with flu-like symptoms. 0. 8onitor hearing loss in clients taking aspirin. 2. 8onitor liver function in clients taking acetaminophen. 5. +-acetylcysteine is antidote for paracetamol overdose. $R'GS AFFEC&% G &HE CAR$%O/ASC'LAR SYS&EM A &%COAG'LA &S Prototy!e " - Eeparin ;91 and .7< Carfarin ;Arally< Mechanism of actions " a. Eeparin - prevents thrombin from converting fibrinogen to fibrin. b. Carfarin - suppress coagulation by acting as an antagonist of vitamin F after ,-# days. %ndications " - thrombosis( pulmonary embolism( myocardial infarction Ad#erse effect " - bleeding ursing considerations "

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1. E&P'G.+ sodium - if given 91 dont aspirate or rub the in=ection site ;above the scapula best site<. - therapeutic level 1.#-2.# times normal P33/ normal P33 is 2"-*# sec. ! #"-2# sec. - antidote 4 ;protamine sulfate< 2. C'G6'G.+ sodium ;coumadin< - warfarin is used for long-term . - onset of action is ,-# days. - therapeutic level is 1.#-2.# times normal P3/ normal P3 ! 5.- -11.2 sec. ! 2# - *" sec. .+G ! 2 - * - should be taken at the same time of the day to maintain at therapeutic level. - reduce intake of green leafy vegetables. - antidote 4 7itamin F ; ' uamephyton< &HROM(OLY&%CS Prototy!e " 9treptokinase( >rokinase Mechanism of actions " - activates plasminogen to generates plasmin ;en?yme that dissolve clots<. %ndications " - use early in the course of 8. ;within ,-- hours of the onset< ursing considerations " - monitor bleeding - antidote 4 'minocarpic acid Anti!latelet Medications Prototy!e" aspirin( :ipyridamole ;Persantin< )lopidoigrel ;Plavix<( 3iclopidine Mechanism of action " - inhibit the aggregation of platelet thereby prolonging bleeding time. %ndications " - used in the prophylaxis of long-term complication following 8..( coronary revasculari?ation( and thrombotic )7'. ursing considerations " - 8onitor bleeding time ; +7 ! 1-5 mins< - 3ake the medication with food. CAR$%AC GLYCOS%$ES Prototy!e" - digoxin ;%anoxin< and digitoxin ;)rystodigin< Mechanism of actions " - increase intracellular calcium( which causes the heart muscle fibers to contract more efficiently( producing positive inotropic D negative chronotropic action. %ndications " - use for )E6( atrial tachycardia and fibrillation ursing considerations " - 8onitor for toxicity as evidence by 4 nausea( vomiting( anorexia( halo vision( confusion( bradycardia and heart blocks . - :o not administer if pulse is less than -" bpm. - 9hould be caution in patient with hypothyroidism and hypokalemia. - 'ntidote 4 :igi-bind - Phenytoin is the drug of choice to manage digitalis-induced arrhythmia. itrates Prototy!e " - isosorbide dinitrate ;.sordil< - nitroglycerine ;:eponit( +itrostat< Mechanism of action " - produce vasodilatation including coronary artery. %ndications " - angina pectoris( 8.( peripheral arterial occlusive disease. Ad#erse effects" - headache( orthostatic hypotension . ursing Considerations " 1. 3ransdermal patch - apply the patch to a hairless area using a new patch and different site each day. - remove the patch after 12-2, hours( allowing 1"-12 hours Lpatch freeM each day to prevent tolerance. 2. 9ublingual medications 4 - note the BP before giving the medication. - offer sips of water before giving because dryness may inhibit absorption. - one tablet for pain and repeat every # mins. for a total of three doses/ if not relieved

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after 1# mins.( seek medical help. - stinging or burning sensation indicates that the tablet is fresh. - instruct patient not to swallow the pill - sustained release medications should be swallowed and not to be crush. - protect the pills from light. A &%1ARRHY&HM%C $R'GS Class % ;block +a channels< %A 1 uinidine( procainamide %( 1 lidocaine %C 1 flecainamide Class %% ;Beta-blockers< propanolol( esmolol Class %%% ;block F channels< amiodarone( bretylium Class %/ ;block )a channels< verapramil( diltia?em ursing considerations " 1. Catch out for signs of )E6. 2. Eave client weigh themselves and report weight gain. *. Catch out for signs of lidocaine toxicity 4 - confusion and restlessness A &%L%PEM%CS Prototy!e " a. cholesterol-lowering agents - cholestyramine( colestipol( lovastatin b. triglyceride-lowering agents - gemfibro?il( clofibrate Mechanism of actions " - interfere with cholesterol synthesis as well as decreasing lipoprotein D triglyceride synthesis. ursing considerations " - monitor liver functions while using statins. - prevent constipation( flatulence( cholelithiasis - encourage increase fluid and fiber intake. A &% 2 HYPER&E S%/E Angiotensin1Con#erting En3yme *ACE, %nhi4itors Prototy!e " captopril ;)apoten<( enalapril ;7asotec<( uinapril( lisinopril Mechanism of actions " - prevent peripheral vasoconstriction by blocking conversion of angiotensin . to angiotensin .. decreasing peripheral resistance. Ad#erse effect " - it cause hyperkalemia - induce chronic cough ursing considerations " - not to discontinue medications because it can cause rebound hypertension. - avoid using FK sparing diuretics. CALC%'M1CHA EL (LOC-ERS Prototy!e " - +ifedipine ;calcibloc( adalat<( 'mlodipine ;norvasc<( 6elodipine ;Plendil< 7erapramil ;.soptin< Mechanism of action " - decrease cardiac contractility and the workload of the heart( thus decreasing the need for A2. - it also promote vasodilatation of the coronary and peripheral vessels. %ndications " - hypertension( angina( arrhythmia Ad#erse effects " - bradycardia( hypotension( headache - reflex tachycardia( constipation ursing considerations " - 'dminister between meals to enhance absorption. - 3ake clients pulse rate before each dose( withhold if pulse is below -" bpm. - Gefer for signs of congestive heart failure. $%'RE&%CS - usually given at morning CAR(O %C A HY$RASE % H%(%&ORS - 'ceta?olimide ;:iamox< - increase +aK( FK( D E)A* secretion( along with it is E2A - metabolic acidosis

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OSMO&%C $%'RE&%C - 8annitol - .ncrease osmotic pressure of the glomerular filtrate. - hypotension &H%A5%$E $%'RE&%CS - hydrochlorothia?ide - blocks +a and F reabsorption/ reabsorb )a - hypercalcemia LOOP $%'RE&%CS - 6urosemide ;%asix< - blocks +a( F( and )a reabsorption - hypocalcemia PO&ASS%'M SPAR% G $%'RE&%CS - 9pironolactone ;'ldactone< - excrete +a and water but it reabsorb F - hyperkalemia RESP%RA&ORY ME$%CA&%O S (ronchodilators Prototy!e " 9ymphatomimetic Ianthines - albuterol( salbutamol - aminophylline - isoproterenol( salmeterol - theophylline - terbutaline Mechanism of actions" - sympathomimetic ;b-receptor agonist< bronchodilators( dilate airways. - xanthine bronchodilators( stimulate )+9 for respiration. %ndications " - bronchospasm( asthma( bronchitis( )AP:. Ad#erse effects " - palpitations and tachycardia - restlessness( nervousness( tremors - anorexia( nausea and vomiting( headache( di??iness. ursing considerations " - )ontraindicated hyperthyroidism( cardiac dysrhythmia( or uncontrolled sei?ure disorder. - 9hould be used with caution in patient with EP+ and narrow-angle glaucoma.

GL'COCOR&%CO%$S ;)AG3.)A93&GA.:9< Prototy!e " - dexamethasone( budesonide( fluticasone( prednisone( beclomethasone. Mechanism of actions " - act as anti-inflammatory agents and reduce edema of the airways( as well as pulmonary edema. Ad#erse effects " - )ushings syndrome( neutropenia. osteoporosis ursing considerations " - 3ake drugs at meal time or with food. - &at foods high in potassium( low in sodium. - .nstruct client to avoid individuals with G3.. - .nstruct client not to stop medication abruptly( it should be tapered to prevent adrenal insufficiency - 'void taking +9'.: while taking steroids. - 3ake inhaled bronchodilators first before taking inhaled steroids( and rinse mouth after using. MAS& CELL S&A(%L%5ERS Prototy!e " cromolyn sodium ;.ntal< Mechanism of action " - stabili?e mast cells that release histamine triggering asthmatic attacks. ursing Consideration" - 9hould be given before asthmatic attacks. - 'dminister oral capsule at least *" mins before meals for better absorption. - :rink a few sips of water before D after inhalation to prevent cough D unpleasant taste - 'ssess for lactose-intolerance. A &%1H%S&AM% ES ;E-1 B%A)F&G9< Protoyty!e " - 'stemi?ole ;Eismanal<( %oratidine ;)laritin<(

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Brompheniramine ;:imetapp<( :iphenhydramine ;Benadryl<( )etiri?ine ;.terax<( )elestamine ;3avist<. Mechanism of action " - decrease nasopharyngeal secretions and decrease nasal itching by blocking histamine in E1-receptor. %ndications " - common colds( rhinitis( nausea and vomiting( urticaria( allergies and as sleep aid. ursing Considerations " - 'dminister with food and drink. - @iven .8 via H-track method or orally. - Precautions in handling machine and driving while taking these drugs. - .ce chips or candy for dry mouth A &%1&'(ERC'LOS%S Prototy!e " First line - .sonia?id ;.+E< - Gifampicin ;Gifadin< - &thambutol - Pyra?inamide - 9treptomycin Second line - )ycloserine - Fanamycin - &thonamide - Para-aminosalicylic acid - given on an empty stomach with 2 "?. of water( 1 hour before or 2 hours after meals and avoid taking antacids with medications. - hepatotoxic thus avoid alcohol. - instruct the client that urine( feces( sweat( and tears will be red-orange in color. Pyra3inamide - given for 2 months. - increase serum uric acid and cause photosensitivity. Etham4utol - contraindicated in children under 1* years old. - obtain a baseline visual acuity because it can cause optic neuritis. - .nstruct the client to notify the physician immediately if any visual problems occurs. Stre!tomycin - aminoglycoside antibiotic given .8. - nephrotoxic and ototoxic. - obtain baseline audiometric test and repeat every 1-2 months because the medications impairs the )+ 7.... $R'GS AFFEC&% G GAS&RO% &ES&% AL SYS&EM Antacids Prototy!e " - aluminum$magnesium compounds ;8aalox< - sodium bicarbonate ;'lka-9elt?er< - calcium carbonate ;3ums< - magnesium hydroxide ;8ilk of 8agnesia<. Mechanism of actions " - neutrali?e the stomach acidity. Ad#erse effects " - metabolic alkalosis( stone formation - electrolyte imbalance - diarrhea ;magnesium<( constipation ;aluminum<. ursing considerations " - @ive 1 hr after meals. - 'void giving medications within 1-2 hrs of antacid administration ;decreases absorption<. - 3ake fluids to flush after intake of antacid suspensions.

- active tuberculosis are treated with drug combination for --5 mos. - multidrug-resistant strain ;8:G-3B< are medicated for 1 year up to 2 years - given before meals %sonia3id - should be given 1 hr before or 2 hrs after meals because food may delay absorption. - should be given at least 1 hr before antacids. - instruct to notify physician for signs of hepatoxicity ;=aundice<( and neurotoxicity numbness of extremities. - administer with 7itamin B- to counteract the neurotoxic side effects. - avoid alcohol. Rifam!icin

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- 8onitor for changes of bowel patterns. - decrease stomach motility and peristalsis. ursing considerations " - 8onitor for rebound constipation. - Be cautious taking if with infectious diarrhea. - 8onitor atropine toxicity with diphenoxylate. - )lay( white or pale stool is common with kaopectate. La0ati#es a. lactulose ;)ephulac<( +a biphosphate ;6leet enema< D magnesium salt ;8ilk of 8agnesia< - retain fluid and distend intestine b. ducosate ;:ialose< - emulsify fecal fat and water c. bisacodyl ;:ulcolax< D senna ;I-prep< - irritates intestinal mucosa and stimulate intestinal smooth muscles d. bulk-forming laxative ;8etamucil< - increase fecal bulk and water content e. mineral oil - lubricates & prevent colon absorption EME&%CS Prototy!e 4 ipecac syrup( apomorphine Mechanism of actions " - induce vomiting through stimulation of vomiting center of medulla. %ndications " - ingestion of poisonous or toxic substances. ursing considerations " - )onsult poison control center before induction of vomiting. - 'dminister ipecac syrup with large amount of fluid. $R'GS AFFEC&% G &HE E $OCR% E SYS&EM &HYRO%$ AGE &S Prototy!e " - Proloid ;thryroglobulin < - 9ynthroid ;levothyroxine< - )ytomel ; liothyronine<. Mechanism of action " - function as natural or synthetic hormones. ursing considerations " - 3aken in the morning.

H%S&AM% E 2 6 (LOC-ERS Prototy!e " - cimetidine ;3agamet<( ranitidine ;Hantac<( famotidine ;Pepcid<( ni?atidine ;'xid<. Mechanism of action" - blocks E2 receptors in the stomach( reducing acid secretions. ursing considerations " - @iven before or with meals - 'void giving other drugs with cimetidine - @ynecomastia may developed with chronic use of cimetidine. Proton 2 Pum! %nhi4itors *PP%, Prototy!e " - omepra?ole ;%osec<( %ansopra?ole ;%an?<( pantopra?ole ;Pantoloc<. Mechanism of action " - inhibit the proton EK to combine with )l- toform hydrochloric acid. ursing considerations " - @iven before meals preferably at morning. Mucosal (arriers Prototy!e " - sucralfate ;)arafate<( misoprostol ;)ytotec<. Mechanism of action " - coats the mucosa to prevent ulcerations. ursing consideration " - @iven before meals. - 8isoprostol is contraindicated for pregnants. - 9ucralfate cause constipation. Anti1diarrheal Agents Prototy!e 4 - diphenoxylate ;%omotil<( loperamide ;.modium<( kaolin$pectin mixture ;Faopectate<. Mechanism of actions "

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- )aution with coronary artery disease. - 8onitor for signs of hyperthyroidism and refer for decreasing the dose. PARA&HYRO%$ AGE &S Prototy!e " a. calcitonin ;)alcimar<( etidronate ;:idronel<( b. calcitrol ;Gocaltrol<( calcifediol ;)alcedrol< Mechanism of action " a. reduce bone resorption b. promotes calcium absorption ursing considerations " - 8onitor signs of calcium imbalance - Geport for bone pains. - Gemain sitting upright after taking etidronate. Oral Hy!oglycemic Agents *OHA, 1. Sulfonylureas - stimulate insulin secretions and increase tissue sensitivity to insulin. 6irst @eneration 4 )hlorpropamide ;:iabenese< - disulfiram precautions 3olbutamide ;Arinase< - congenital defect 9econd @eneration 4 @lypi?ide( @lymepiride 2. (iguanides - facilitates insulin action on the peripheral receptor site. 8etformin and @lucophage ;@lucovance< - side effect is lactic acidosis *. Al!ha1glucosidase inhi4itors - delay carbohydrate absorption in the intestinal system. 'carbose ;Precose< side effect is diarrhea ,. &hia3olinidine - increase tissue sensitivity of insulin. Gosiglita?one ;'vandia< #. Meglitinides - stimulate insulin release in pancreatic B-cells. Gepaglinide ;Prandin< ursing considerations " - &ffective only for type .. :8. - )ontraindicated to pregnant D breastfeeding. - @iven before meals. - 8onitor for signs of hypoglycemia.

%nsulin .nsulin .mmediate-acting ;lispro< 9hort-acting ;regular( semilente< .ntermediate-acting ;+PE( lente< %ong-acting ;ultralente< 8ixed ;regular *"N( +PE 0"N<

Anset ".1#h

Peak ".#1h

:uration #h #-0h 12-2, h 2,-*- h 2# h

".#-1 h 2-, h 1-* h --12 h

,--h 1"-*" h ".# h ,-2 h

ursing considerations " - >sually given before meals. - Goll the bottle in palm of hands( dont shake. - .n=ect amount of air that is e ual to each dose into the bottle short acting last ;clear<. - 'spirate short acting first( then long or intermediate ;cloudy<. - 'lcohol is recommended for cleansing bottle but not with skin. - Pinch skin( avoid ..8( dont aspirate. - Gotate the in=ection site an inch a part. - Prefilled syringes are stored vertically( needle-up. - 8ay increase dose during illnesses. - >sed bottles stored in room temperature( unused bottle stored in refrigerator. - 8onitor for acute hypoglycemia 4 a. *-, commercially prepared glucose tablet b. ,-- ounce of fruit =uice or regular soda c. 2-* teaspoon or honey d. @lucagon 1 gm 91 or .8 e. :#"-#" .7. ES&ROGE S A $ PROGES&% S

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Prototy!e " - con=ugated estrogen ;Premarin<( estrone ;Bestrone<( estradiol ;&strace<( diethylstilbestrol ;:&9<. %ndications " - prostate cancer( contraceptions - estrogen replacement Ad#erse effects " estrogen - endometrial )'( gallbladder disease( EP+( migraine( breast tenderness progesterone - altered menstrual flow( risk of thrombo embolism ursing considerations " 1. 8ix estrogen or progestins prior to .8 administration by rolling vials between palms. 2. 8onitor blood pressure *. 3each patient how to perform B9&. ,. Gegular follow-up examination is re uired to detect associated risk of ac uiring )' $R'GS AFFEC&% G LA(OR and LAC&A&%O 'terine Stimulating Agents Protoyt!e " a. Axytocin ;Pitocin<( ergonovine ;&rgotrate<( methylergonovine ;methergine< b. carbopost ;Prostin<( dinoprostone ;Prostin &2< Mechanism of actions " a. stimulates uterine smooth muscles b. ripening of cervix Ad#erse reactions " - fetal bradycardia ;oxytocin<( - hypertension ;ergonovine<( palpitations - allergic reactions ;Prostaglandins< 'terine %nhi4iting Agents ;3ocolytic< Prototy!e " - ritodrine ;Outopar<( terbutaline ;Brethine< Mechanism of actions " - relaxes the uterus by stimulating the B2- adrenergic receptors Ad#erse effects " - tremors( nausea( vomiting and tachycardia Lactation Su!!ressants Prototy!e " - bromocriptine ;Parlodel< Mechanism of action " - decrease serum prolactin levels Ad#erse effects " - drowsiness( headache( nausea( palpitations $R'GS FOR &REA&% G % FEC&%O Anti4acterial Agents 1. Cell 7all inhi4itors a. penicillins - pen @( amoxicillin( cloxacillin b. cephalosphorins - cephalexin( cefaclor c. glycopeptide - vancomycin 2. Protein synthesis inhi4itors a. aminoglycosides - amikacin( gentamycin b. macrolide - erythromycins( roxithromycin c. lincosamides - clindamycins d. chloramphenicol( tetracyclines *. Antimeta4olites - blocks folic acid synthesis a. 9ulfonamides - cotrimoxa?ole ,. $ A synthesis inhi4itors a. uinolones - ciprofloxacin( ofloxacin b. metronida?ole Ad#erse effects " 1. 'minoglycoside - nephrotoxicity D ototoxicity 2. 9ulfonamides - 9teven-Pohnsons syndrome( photosynsetivity *. 1uinolones - insomnia ,. 3etracyclines - bone problems #. )hloramphenicol - @ray syndrome( bone marrow depression -. &rythromycin - hepatitis ursing considerations " 1. )ollect appropriate specimen for ) D 9 before starting antibiotics. 2. )heck clients history of allergies. *. 'void administering erythromycin and uinolones with food. ,. Pregnant precautions. #. Geport for diarrhea - pseudomembranous colitis ;clindamycin< -. 8onitor adverse effects. Anti#iral Agents

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Prototy!e " - acyclovir ;Hovirax<( ganciclovir ;)ytovene<( vidarabine ;7ira-'<( amantidine ;9ymmetrel<( ribavirin ;7ira?ole<( ?idovidine ;Getrovir<. Mechanism of actions " - inhibits virus specific en?ymes involve in :+' synthesis. 3hey only control the growth of virus but it does not cure. Ad#erse effects " - granulocytopenia( thrombocytopenia( nausea( nervousness( headache( nephrotoxicity. ursing consideration " - Pregnant and breastfeeding precautions. - 'dminister .7 antivirals to avoid crystalli?ation in renal tubules. - @ive ribavirin only with aerosol generator. - 8onitor )B) and creatinine level. - Gefer for signs of bleeding. - 3ake amantidine after meals. Antifungal Agents Prototy!e " - amphotericin B ;6ungisone<( nystatin( flucona?ole ;:iflucan<( ketocona?ole ;+i?oral<. Mechanism of actions " - inhibit the synthesis of fungal sterol. Ad#erse effects " - nephrotoxicity and neurotoxicity - bone marrow depression - chills( fever( =oint pains( abdominal pain and headache. ursing considerations " - :ilute amphotericin B with sterile water solution not with electrolyte solution. - 3ell clients that fever( chills( @. upset( =oint and muscle pain will subside as amphotericin B continues. - Cith oral candidiasis( let nystatin tablet dissolve in mouth rather than swallowing it. - Gefrain ketocona?ole with antacids. - Geport for signs of bleeding( infection D fatigue.

A &%PARAS%&%C AGE &S Prototy!e " a. 'ntimalarial - chlro uine( meflo uine( prima uine( uinine( pyrimethamine b. 'ntiamebiasis - metronida?ole ;6lagyl<( iodo uinol( furo?olidone ;6uroxone<. Mechanism of actions " a. antimalarial alters proto?oal :+'( depleting folates( D reducing nucleic acid production b. antiamoeba block protein synthesis. ursing considerations " 1. 'dminister anti-malarial drugs with food. 2. 3ake sei?ure precautions while administering antimalarial drugs. *. Gefer cinchonism during uinine treatment4 - tinnitus( headache( vertigo( fever( and visual changes. ,. .nform clients that iodo uinol falsify thyroid function test for up to months. A &%HELM% &%C Prototy!e " - mebenda?ole ;7ermox<( thiabenda?ole( niclosamide ;+iclocide<( pipera?ine ;'ntepar<( pra?i uantel ;Biltricide<. Mechanism of actions " - paraly?e larva and adult helmints by acting on parasite microtubules. Ad#erse effects " - @. upset( urinary odor ;thiabenda?ole< - headache( di??iness( fatigue ursing considerations " 1. 3reat all the family members for nematodes infection to prevent recurrence. 2. Pra?i uantel must swallowed rapidly because of its bitter taste to avoid gagging. *. Ather antihelmintics should be chewed.

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A &%1 EOPLAS&%C $R'GS General considerations " - kills or inhibit the reproduction of neoplasmic cells but as well as normal cells. - it could be cell cycle phase specific or cell cycle non-specific. - preferably given through .7 route. Prototy!e " 1. Al)ylating Agents - inhibits cell production by causing cross linking of :+' a. Busulfan hyperuricemia b. )hlorambucil gonadal suppression c. )isplatin ototoxicity and nephrotoxicity d. )yclophosphamide hemorrhagic cystitis. 2. Antitumor Anti4iotic Agents - interfere in :+' and G+' synthesis a. Plicamycin affects bleeding time b. :oxurubicin cardiotoxicity c. Bleomycin pulmonary toxicity. *. Antimeta4olites - replace normal proteins re uired for :+' synthesis by inhibiting the 9 phase a. )ytarabine hepatotoxicity b. #-flourouracil phototoxicity reaction and cerebellar dysfunctions c. --marcaptopurine hyperuricemia d. 8ethotrexate photosensitivity - given with leucoverin to lessen its toxicity. ,. Mitotic %nhi4itors */inca Al)aloids, - prevent mitosis acting on the 8 phase causing cell death a. 7incristine sulfate neurotoxicity( numbness #. Hormonal Medications and En3ymes - block the normal hormones in hormone sensitive tumors a. 3amoxifen citrate visual problems elevate cholesterol D triglycerides level b. :iethylstilbestrol impotence and gynecomastia in men. Side Effects" stomatitis - bland diet( avoid strong mouthwash - soft tooth brush( ice chips diarrhea( nausea and vomiting - anti-emetic( replace fluids and electrolytes alopecia - reassure that it is temporary - encourage o wear wigs( hats and head scarf skin pigmentation - inform that it is only temporary tumor lysis syndrome - hyperuricemia D hyperkalemia - force fluids infection - notify physician if CB) is Q2"""$mm* - monitor for signs of infection - reverse isolation - low bacteria diet anemia - iron( B-12( folic acid rich food - provide rest periods bleeding - avoid +9'.:s - minimi?e invasive procedures - use soft toothbrush and electric ra?or menstrual changes - reassure that menstruation will resume. &HE E $ RE/%E8 9'ES&%O S S%&'A&%O " Mr: Hero Fernando+ a ;< year1old 4an) manager had e0!erienced a sensation of chest tightness+ chest !ain+ s7eating and a feeling of a!!rehension: A diagnosis of CA$ 7ith angina !ectoris 7as esta4lished 1. 3he physician orders for nitroglycerin tablet. 3he nurse knows that the pharmacological action of the drug is4 a. 3o dissolve the atheromatous pla ue in the coronary artery b. )onstrict the venous vessels and capillaries c. :ilate the coronary arteries d. :ecrease the myocardial consumption of oxygen

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2. 3he nurse gave instructions to the patient on nitroglycerin intake. Ee remarked( L. think . will try not to take too many of these pills.M 't this instance( the nurses B&93 reply would be4 a. L. agree( nitroglycerin can cause drug addiction( that is why you must not take too many of the pillsM b. L. must inform you that nitroglycerin is non-habituating and you should take the pills many times to relieve the painM c. LOou will be needing only three tablets to ease the pain and if unrelieved( you must seek medical attentionM d. L 3here is no problem with continuous daily intake because nitroglycerin does not cause a tolerance effectM 3. 3he nurse must emphasi?e to the patient which A+& of the following side-effects of nitroglycerin4 a. Eeadache c. +ausea and vomiting b. Eypertension d. 7isual changes 4. Chat other information must the nurse provide to the patient taking the nitroglycerinR a. Feep the tablet in a clear container b. 3ake the tablet with meals c. )ontinue to take as many tablets of nitroglycerin until chest pain subsides d. ' burning sensation under the tongue is expected 7. Eero asked the nurse what he could do about his concern about sex activity. 3he nurse best suggests4 a. 3ell him to avoid sex for several months while his heart is on therapy b. 9uggests that his wife assume the top position c. 3ell him to avoid sex on days when he is anxious d. 'dvise that he should have sex only once a month 8. 3he nurse understands that her discharge teaching is effective regarding life style modification when the patient says4 a. L. know that . will need to eat less( so . will eat once a day onlyM b. L. will stay on bed most of the time so . wont experience chest painM c. L. will stop what .m doing whenever . have pain and take the pillM d. L. need to enroll in a gym class to have a vigorous exercise to condition my heartM S%&'A&%O 4 8anny is admitted to the medical ward with the diagnosis of essential hypertension. Ee had hypertensive emergency 2 hours ago and was hospitali?ed for further observation. 9. 3he nurse administers prescribed anti-hypertensive meds. .f it can be any of the following( she will check the pulse prior to giving4 a. +ifedipine b. 8etoprolol c. )lonidine d. )aptopril 10. 'fter administering a blood-pressure lowing agent( the nurse must caution the patient4 a. 3o avoid straining during defecation b. 3o avoid low-sodium and potassium diet c. 3o avoid abrupt change of positions d. 3o take warm shower immediately after taking the drug 11. 3he nurse prepares to give a diet appropriate for a hypertensive patient. Chich food should the nurse include in the menuR a. )anned meat loaf b. 9callops and shrimps c. 6resh citrus =uice and cake

5. 3he nurse applies the ordered nitroglycerin ointment on the patients chest wall. Chich nursing action is considered inappropriateR a. 3he nurse chooses a hairless area b. 9he spreads the ointment with her fingers c. 9he removes the ointment on the skin from the previous dose d. 9he rotates the sites of ointment application 6. 3he nurse gives which of the following discharge instructions to this patient with angina regarding nitroglycerin therapyR a. Anly take the nitroglycerin as desired b. 3he drug should be taken before engaging in exertional activities c. 3he tablet should be taken only in the morning d. .f the drug does not relieve the pain( increase the fre uency of the dose

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d. Butter and pork steaks 12. .f the physician orders )aptopril as the home medication for the high BP( the nurse must caution that the side-effect of this drug that is disturbing is4 a. Gashes b. )ough c. Pruritus d. Ginging of the ears 13. .f the client is discharged with home medication of Propranolol hydrochloride( the nurse must include in her medication-teaching plan which oneR a. 3ake the medication on an empty stomach b. Abtain blood pressure readings regularly c. Perform active exercises to prevent Eypotension d. )aution to avoid ha?ardous activities after taking the drug 14. 3he nurse determines that the following drugs are calcium channel blockers that can be prescribed by the physician to the patient. Ane is not included4 a. +ifedipine b. 7erapamil c. 3elmisartan d. :iltia?em S%&'A&%O 4 Poseph(( #" y.o. Businessman awakens in the middle of the night with dyspnea( bilateral basilar rales and frothy sputum. Ee is brought to the 8ulawin hospital. Eis diagnosis is congestive heart failure. 15. 3he physician gives the patient furosemide and digoxin. 3he nurses main concern is to4 a. 3ake the central venous pressure reading b. Abserve for decrease edema c. Abserve for signs and symptoms of hypokalemia d. 6orce fluids 16. 3he mechanism of action of dioxin that makes it useful in patients with )E6 is that it4 a. Produces a negative inotropic effect b. .ncreases cardiac conduction c. &nhances cardiac contractility d. .ncreases the heart rate 17. 3he nurse is very vigilant about digoxin overdose. Chich one statement below by the patient may alert the nurse of a possible development of toxicityR a. L+urse( . dont feel like eating for the past few daysM b. L. am having constipation latelyM c. L. am developing a nagging cough and night terrorsM d. L. am experiencing dryness of the eyes and sandy sensationM 18. 3he nurse evaluates that the drug digoxin is effective when the patient manifests4 a. :ecreased bowel sounds b. .ncreased urine output c. .ncreased drowsiness d. :ecreased sympathetic response of the body 19. 3he following manifestations must be assessed by the nurse to detect beginning digitalis toxicity( with the exception of4 a. +ausea and vomiting b. Palpitations c. :iplopia and visual yellow-green halos d. Eypertension 20. 3he nurse instructs the patient on diet modification during digitalis therapy. 9he is certain that her teaching is effective when the patient will choose all the foods items below( except4 a. 6resh orange =uice and potato fries b. :ried mangoes and tomato =uice c. Broccoli salad with bean sprouts d. 6lavored gelatin and iced tea 21. 3he nurse obtains an apical pulse of 02 beats$min. 9he is bringing the next dose of digoxin and then proceeds to do which one action belowR a. Cithhold the drug and notify the physician b. 9tart .7 infusion of :igibind ;digoxin antibody< c. .nstruct patient to consume more meat and nuts d. 'dminister the drug S%&'A&%O 4 'rmida( an 12-year-old adolescent is seen in the health center because of easy fatigability and fre uent di??iness

18
22. 3he health center physician determines that she has iron-deficiency anemia. 3he nurse will anticipate the doctor to order for4 a. Bone marrow aspiration b. Eemoglobin level determination c. Platelet count d. B>+ and )reatinine 23. ' drug is administered to correct anemia( such as an iron. 3his drug is classified as4 a. 'ntihelminthic b. 'nticoagulant c. Eematinic d. 'ntihistaminic 24. 3he nurse administers the oral iron tablet. 9he will give the medication4 a. Cith milk and dairy products b. Cith antacids to minimi?e gastric upset c. Cith fruit =uices like calamansi and orange d. Cith a full glass of coffee or tea 25. 3he nurse instructs the patient to eat iron-rich foods. 9he determines that her teaching is effective when the client will choose4 a. Pomelo =uice and hamburger b. @elatin and marshmallows c. %ean meat and buttered corn d. %iver and eggyolk 26. 3he doctor decides to order .ron dextran one ampoule. 3he nurse prepares to administer the drug4 a. .ntravenously. 9low .7 push b. .ntamuscular( H-track method c. 9ubcutaneous d. .ntrathecal 27. 3he nurse must warn the patient taking oral iron preparations that it can cause which side effect$sR a. Oellowish discoloration of the skin and mucus membrane b. :arkening of stool color c. 'norexia and loss of hair d. >lceration of the skin and cough 28. 3he patient remained pale and weak( upon further examination( it was determined that she has pernicious anemia. 3he pathophysiology of this hematological disorder is4 a. 'bsence of 7itamin & in the diet b. Presence of excessive iron in the liver c. 'bsence of intrinsic factor in the stomach d. 3emporary bone marrow depression. $R'GS &HA& AFFEC& &HE HEMA&OLOG%CAL SYS&EM S%&'A&%O 4 8rs. Gosalinda 'mor( 2* year-old actress is admitted because of a diagnosis of deep vein thrombosis. 29. 3he nurse employs which of the following non-pharmacological measures in caring for 8rs. 'morR a. .ce compress over the involved leg 3.: b. &levate the legs with a pillow c. 8aintain on strict bed rest with minimal bathroom privileges d. 8assage the involved area 30. 3he physician orders Eeparin sodium for 8rs. 'mor. 3he nurse understands the reason for this therapy is that4 a. Eeparin will dissolve the clots in the inflamed veins to prevent emoboli?ation b. 3here is a need to prevent further clot formation in the involved vessels c. Eeparin will anticoauglate the blood by inhibiting vitamin F metabolism d. 3he clot formed in the vein must be lysed by activating plasmin( the action of heparin 31. .f the doctor orders for heparin therapy monitoring( the nurse must obtain which laboratory tests from the lab unitR a. Prothrombin time b. )lotting time c. Partial thromboplastin time d. Prothrombin consumption test 32. 3he above laboratory value must is considered therapeutic if the result is about4 a. * times the normal b. 2 times the normal c. & uals the normal d. %ess than the normal

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33. 3he nurse must administer heparin to 8rs. 'mor. 9he determines that the most common routes of administration are4 a. .7 and .8 b. 9) and .7 c. .: and .8 d. .7 and intrathecal 34. Chen the nurse is monitoring the patient for heparin overdose( she is observing for the following signs$symptoms( exceptR a. &cchymoses b. Positive Eomans sign c. :ark( cola-colored urine d. &pistaxis 35. Chich one effect of heparin therapy will cause nursing concernR a. 3hrombocytopenia b. )onstipation c. Bone marrow depression d. :i??iness 36. .n the event of an overdose of heparin in=ection( the nurse prepares which one antidote for toxicityR a. Phytomenadione b. 'tropine 9ulfate c. Protamine sulfate d. :eferoxamine chelators 37. 3he doctor switched from standard heparin to low molecular weight heparin in=ection. 3he advantage of %8CE over the standard heparin is4 a. 3he %8CE can be administered .8 b. 3he %8CE does not need fre uent laboratory monitoring c. 3he %8CE has a better potency d. 3he %8CE does not cause bleeding problems 38. 3he nurse reads the chart and notes for an order of oral Carfarin sodium( while the patient is on heparin therapy. 3he nurse will4 a. 1uestion the order because of potential excessive bleeding if given simultaneously b. 'dminister the drug as ordered c. Cithhold the heparin and administer the Carfarin orally d. Geport the error to the nurse supervisor as the patient may be at risk for toxicity 39. .6 8rs. 'mor is discharge with warfarin sodium( the nurse must include in her discharge teaching which oneR a. Feep 7itamin ' ampule available for in=ection c$o the health center in case of emergency b. Geport any bright red blood in the stool or urine c. 3ake aspirin to manage the headache side-effect of the drug d. >tili?e firm toothbrush when brushing to prevent build up of pla ues and gingival hyperplasia 40. 3he nurse must remind the patient that warfarin therapy is monitored with the use of which laboratory examinationsR a. P3 and P33 b. P3 and .+G c. )lotting time and bleeding time d. Platelet count and P3 S%&'A&%O 4 8rs. 'very had a previous attack of mild stroke and coronary artery disease. 9he is taking 'spirin. 41. 3he reason aspirin is utili?ed as an anti-platelet medication is because4 a. 'spirin can prolong the bleeding time b. 'spirin affects the thromboxane production of the platelet c. 'spirin interferes with the receptor binding of the platelets d. 'spirin blocks the degranulation process inhibiting release of histamine 42. 3he nurse administers aspirin4 a. An an empty stomach to increase absorption b. Cith meals c. .n Between meals d. .ntramuscularly 43. 8rs. 'very had a sudden severe and prolonged chest pain. 'cute 8. is suspected. 3he nurse anticipates the doctor to order a fibrinolytic( and this may be4 a. 3ranexamic 'cid b. :ipyridamole c. 9teptokinase d. )oumadin

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44. .f the above drug is ordered to be given .7 drip( the nurse must be aware of which potential effectR a. Eypersensitivity reaction b. )ongestive heart failure c. 6urther damage to the myocardium d. &xcessive clot formation 45. .f the patient is receiving tissue-plasminogen activator( the nurse must make which one priority interventionR a. Eave heparin sodium available b. 8onitor closely the renal status c. Abserve for psychotic symptoms d. Abtain a stand by 'minocaproic acid S%&'A&%O 4 ' patient is determined to have hypercholesterolemia and is admitted in the hospital for treatment of her condition. 3he doctor ordered %ovastatin A:. 46. 3he nurse determines that the B&93 time to give the drug is4 a. .n the morning before breakfast to promote absorption b. .n the afternoon to promote sleep because it is sedating c. 't bedtime d. .n between meals 47. 3he nurse is knowledgeable about the mode of action of lovastatin that it4 a. .t .nhibits the formation of chylomicrons in the intestinal cells b. .t prevents the en?yme that synthesi?es cholesterol c. .t binds with bile acids and cholesterol promoting excretion d. .t promotes cholesterol metabolism in the adipose tissue to lower the plasma cholestero 48. 3he nurse is prepared to provide comfort measure to the common side effects of the drug. 9he monitors the patient for4 a. 'bdominal fullness( flatulence and diarrhea b. )onfusion and psychoses c. Palpitations and arrhythmias d. Eypertension and rashes 49. 3he nurse must monitor for these serious adverse effects of lovastatin. Chich one is not includedR a. @laucoma b. )ataract c. 8yositis d. Eepatic failure 3he nurse reads the drug order sheet and is most concern to consult the physician if he orders4 e. Paracetamol f. @emfibro?il g. 7itamin supplements h. Amepra?ole 50. 3he nurse is giving @uaifenesin to a patient. 9he includes in her teaching which of the following interventionsR a. Carn the patient that extreme drowsiness may occur b. Affer a full glass of water c. +ausea and vomiting are potential problems alleviated by small fre uent meals d. 9uggest to buy a nebuli?er machine to be used at home e. 7itamin ':&F supplements because of impaired absorption 51. 3o be able to detect the effectiveness of 9albutamol( the nurse should check for4 a. Blood pressure and )7P readings b. >rinary output per hour c. Breath sounds d. %evel of consciousness e. Pupillary reflexes 52. 3he patient is receiving theophylline capsule A:. 3he nurse cautions the patient to avoid foods with components similar to theophyline and they can be4 a. 9ugar and cream b. )offee and chocolate c. 9pinach and broccoli d. Beans and aged cheese e. )anned goods and wine 53. 3he patient is receiving theophylline capsule A:. 3he nurse cautions the patient to avoid foods with components similar to theophyline and they can be4 a. 9ugar and cream b. )offee and chocolate

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c. 9pinach and broccoli d. Beans and aged cheese e. )anned goods and wine 54. 3he nurse is administering acetylcysteine nebuli?ation to a patient. .t is very much important to keep which item below at bedsideR a. 9cissors b. 'mbu bag c. 9uction machine d. 3racheostmy set e. +@ tube 55. 'fter giving diphenhydramine to the patient( the nurse must ensure that the patient understands the teachings below( EXCEPT4 a. Gefrain from manipulating delicate machines b. 3ake sugarless candy in the mouth to relieve dryness c. 'void taking the drug with alcohol d. )heck pulse rate before taking the drug e. 8anage gastric upset by taking it with food 56. 3he nurse watches out for a side-effect associated with intake of codeine sulfate and provides appropriate intervention( this can be4 a. )onstipation- provide liberal fluids b. &xcitement- provide less stimulation c. 3achycardia- administer lidocaine d. Polyuria- give the drug in the morning e. 3achypnea- position on semi-fowlers a. .nstruct the patient to clear the nasal passage of mucus before instilling b. Gemind patient to keep the head tilted for a few seconds after administration c. 'dvise increased fluid intake d. &ncourage the use for one week for better effect e. )aution that tachycardia and urinary retention may occur with systemic absorption 59. 3he physician asks the nurse for an anticholinergic drug to be used for the asthmatic patient. 3he nurse obtains from the pharmacy which drugR a. 'lbuterol b. 3erbutaline c. 8etaproterenol d. .pratropium bromide e. 9albutamol 60. 3he physician orders dextromethorphan for a patient who is complaining of very uncomfortable coughing. 3he nurse understands that this drug acts to suppress cough by4 a. .ncreasing the secretions of the bronchial glands b. Gemoving the irritation from the respiratory tract c. .nhibiting the medulla oblongata cough center d. .nhibiting the stretch receptors in the lungs e. 3riggering the vagal responses 61. .nhaled corticosteroid like beclomethasone is administered to the patient with asthma. .t is important for the nurse to stress that this drug4 a. 'cts rapidly to decrease inflammation b. Promotes the secretion of mucus c. 8ay depress the immune function d. Eighly effective in terminating acute asthma attack e. .s habituating and addicting 62. 3he second generation anti-histamines like cetiri?ine have the advantage over the first generation antihistamines like diphenhydramine because second generation antihistamines4 a. Eave shorter duration of action that can be reversed rapidly b. Eave less sedation and anticholinergic properties c. Posses less drug sensitivity reactions

57. 3erbutaline sulfate is administered to a patient with asthma. .f the patient has another disease( the nurse is most vigilant and cautious if this condition exists4 a. Eypothyroidism b. Gheumatoid arthritis c. :iabetes mellitus d. Polycystic ovarian disease e. &mphysema 58. 3he nurse is administering oxymeta?oline nasal decongestant. 9he includes in her care plan all of the following interventions( EXCEPTR

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d. Eave a greater safety profile e. Eave less abuse potential 63. 3he nurse cautions the patient taking diphenhydramine ;Benadryl< to expect all of the following side effects( exceptR a. :ry mouth b. Blurred vision c. >rinary fre uency d. :rowsiness e. :i??iness 64. 3he nurse must remember to administer theophylline slowly or with an infusion pump because this drug( if given rapidly can cause4 a. .ncreased alertness b. 9evere hypotension c. 3achycardia d. Pallor e. Eeadache

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