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Tuesday, November 11, 2008

Nclex Pharmacology Study Guide - Passing Nclex-RN

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With carbidopa/levodopa therapy, a darkening of the urine or sweat may occur. The client should be reassured that this is a harmless side effect of the medication, and its use should be continued.

Clorazepate (traxene) is classified as an anticonvulsant, antianxiety agent, and sedative/hypnotic (benzodiazepine). The medication can lead to physical or psychological dependence when there is prolonged therapy at high doses. For this reason, the amount of medication that is readily available to the client at any one time is restricted.

Diuretic therapy should be administered in the morning to cause the least disruption possible in the client’s sleep cycle.

Hypokalemia can make the client more susceptible to digoxin toxicity. The nurse monitors the results of potassium levels drawn on the client. The normal reference range of potassium for an adult is 3.5 to 5.1 mEq/L. If the potassium level is low, the dose is withheld and the physician is notified. In this situation, the dose should be administered as prescribed because the potassium level is within the normal range.

Heparin therapy is contraindicated with preexisting health conditions such as threatened abortion, active hemorrhage, cerebrovascular hemorrhage, cerebral or aortic aneurysm, severe hypertension, hemophilia, thrombocytopenia, pericarditis, and recent or upcoming ophthalmic or neurosurgery. Caution should be used if the risk of hemorrhage is present, such as in recent childbirth, severe diabetes mellitus, vasculitis or trauma, significant renal impairment, and active lesions of the respiratory, gastrointestinal, or genitourinary tracts. The presence of deep vein thrombosis is a reason for administering heparin.

Lidocaine is a medication used to treat ventricular dysrhythmias. Lidocaine exerts a local anesthetic effect on the heart, thus decreases myocardial irritability.

A client taking furosemide (Lasix) must be able to monitor fluid status throughout therapy. Monitoring daily weight is the easiest and most accurate way to accomplish this.

Glucocorticoids increase gastric secretion and this can result in peptic ulcers and gastrointestinal bleeding. Corticosteroids increase blood glucose.

Digoxin is a cardiac glycoside and hydrochlorothiazide is a diuretic. Clients taking digoxin have an increased risk of digoxin toxicity from the potassium-depleting effect of hydrochlorothiazide. Therefore the diet should be high in potassium. The client should take the pulse before taking cardiac glycosides. A combined therapeutic effect of these medications is to increase urine output. The increased blood flow to the kidneys from enhanced cardiac contractility from the digoxin will promote urinary output. Hydrochlorothiazide increases urine excretion of sodium and water by inhibiting sodium resorption in the nephron. For best therapeutic effects, these medications should be taken at the same time in the morning to avoid sleep disturbances from the need to urinate.

Clients receiving amphotericin B (Fungizone) may develop hypokalemia, which can be severe and lead to extreme muscle weakness and ECG changes. Distal renal tubular acidosis commonly occurs, contributing to the development of hypokalemia.

Scopolamine is an anticholinergic medication that causes the frequent side effects of dry mouth, urinary retention, decreased sweating, and dilation of the pupils.

Because of the vasodilating effects of nitrates, headache is a common side effect. Medical attention is not needed unless the headaches increase in severity or frequency. All three medications are nitrates, which improve myocardial circulation by dilating coronary arteries and collateral vessels, thus increasing blood flow to the heart. These medications are used to help prevent the frequency, intensity, and duration of anginal attacks. Nitrates should be stored in a cool place and in a dark container. Heat and light cause these medications to break down and lose their potency.

Foods high in vitamin B6 can counteract the effects of carbidopa/levodopa, and their intake should be limited.

A client taking pheytoin (Dilantin) for seizure precautions would require the doctor to stop the medication if the client experiences diffuse body rash. Stevens-Johnson syndrome is a rash indicating an allergy, and if this occurs the physician needs to be notified in order to consider medication discontinuation.

Adenosine (Adenocard) is an antidysrhythmic used in the treatment of paroxysmal supraventricular tachycardia. Cardiac status must be assessed before and throughout treatment by a cardiac monitor.

Drowsiness, diarrhea, and hepatotoxicity are the major adverse effects of this muscle relaxant, which is used to treat the chronic spasticity seen in spinal cord injury. The drowsiness may interfere with the client’s rehabilitation. Some clients have anorexia and hematuria.

Hydralazine hydrochloride (Apresoline) is a potent ganglionic blocking agent that will decrease the blood pressure by vasodilation. It may be given by slow intravenous push during an episode of extreme hypertension.

Clients receiving amphotericin B may develop nephrotoxicity. Clients should be monitored for oliguria, hematuria, cloudy urine, decreased urine output, and elevated renal function laboratory values. Amphotericin B does not cause the urine to turn orange.

Acetylcysteine is the antidote for acetaminophen. Protamine sulfate is the antidote for heparin. Phytonadione is the antidote for warfarin sodium (Coumadin). Pancreatin is a pancreatic enzyme replacement or supplement.

Acetazolamide (Diamox) is a carbonic anhydrase inhibitor used in the treatment of open-angle, secondary, or angle closure glaucoma to reduce the rate of aqueous humor formation and to lower intraocular pressure. Adverse effects relate to nephrotoxicity, hepatotoxicity, and bone marrow depression. Jaundice is a sign of hepatotoxicity. A decrease in the level of peripheral vision would indicate a complication of glaucoma. Pupillary constriction in response to light is a normal response.

Acebutolol (Sectral) is a beta-adrenergic blocker used primarily to manage mild to moderate hypertension or cardiac dysrhythmias. The expected therapeutic response is a controlled blood pressure within normal limits

Acyclovir (ZOvirax) is an antiviral medication used to treat the herpes virus. Rapid parenteral administration, excessively high doses, or fluid and electrolyte imbalances may produce renal failure. Abdominal pain, decreased urination, decreased appetite, increased thirst, and nausea or vomiting can occur. Lightheadedness and headache are occasional side effects of oral use. Tremors are a rare side effect of parenteral use.

A major concern when initiating thyroid hormone replacement therapy is that the dose may be too high, which can lead to cardiovascular problems. As a result, clients need to be aware of the early signs and symptoms of toxicity and of the need to report these immediately to their physician. Diarrhea, insomnia, and excessive sweating are signs and symptoms of hyperthyroidism, and while they can occur with thyroid replacement therapy, they are not expected and should be reported. Tremors and nervousness are also signs of toxicity, which need to be reported. Clients should never take it upon themselves to adjust hormone dosage. Levothyroxine sodium is not administered topically. Any episode of palpitation, chest pain or dyspnea needs to be reported to yoru doctor.

Niacin (Nicobid, Niacor) is used as adjunctive therapy in the management of hyperlipidemia. This is used in conjunction with a low fat and cholesterol diet, exercise, and smoking cessation. Serum cholesterol and triglyceride levels are monitored periodically to assess the effectiveness of therapy.

Medication-specific teaching points for quinidine sulfate (Quinidex Extentabs) include taking the medication exactly as prescribed; not chewing the sustained release tablets; taking with food if GI upset occurs; wearing a Medic-Alert bracelet or tag; and the need for periodic checks of heart rhythm and blood. This medication is initiated for atrial flutter or fibrillation only after the patient has been digitalized

The client with Addison’s disease will require lifelong replacement of adrenal hormones. The medications must be taken daily, and an alternate route of administration must be used if the client cannot take oral medications for any reason, such as nausea and vomiting. Additional doses of glucocorticoids will be needed during times of acute stress. The nurse must stress that the client must call the physician to obtain a dosage increase when experiencing stressful situations. Abrupt withdrawal of this medication can result in Addisonian crisis. Although side effects are not severe at lower doses, side effects may be experienced with glucocorticoid administration. It is very unsafe to stop taking the medication without first consulting the physician.

Amantadine hydrochloride (Symmetrel) is an antiparkinson agent, which potentiates the action of dopamine in the central nervous system. The expected effect of therapy is a decrease in akinesia and rigidity. Leukopenia, urinary retention, and hypotension are all adverse effects of the medication.

An oral airway may be used to keep the client from biting down, occluding an orotracheal tube. A nasal airway is not used in conjunction with an oral endotracheal tube.

Human albumin (Albuminar) is classified as a blood derivative and is contraindicated in severe anemia, cardiac failure, history of allergic reaction, renal insufficiency, and when no albumin deficiency is present. It is used with caution for clients with low cardiac reserve, pulmonary disease, or hepatic, or renal failure.

Nitrofurantoin sodium (Macrodantin) is an antibacterial used to treat acute urinary tract infection, or is used as chronic suppressive treatment of urinary tract infection. It is not effective with systemic bacterial infections.

Nifedipine (Procardia) is a calcium antagonist that reduces smooth muscle contractibility by inhibiting the movement of calcium ions in slow channels. Its side effects include headache, flushing, peripheral edema, and postural hypotension. Overdose of the medication produces nausea, drowsiness, confusion, and slurred speech. If signs of overdose occur, the physician is notified.

The initial adverse effects of zidovudine (AZT) include headache, malaise, insomnia, rash, diarrhea, and fever. As AZT therapy proceeds, these symptoms become more tolerable. If anemia or neutropenia occur, the medication will be discontinued or the therapy will be temporarily interrupted.

A client who is taking anticoagulants should ingest no over-the-counter medications of any kind. This is especially true of aspirin and/or aspirin-containing products (due to potential to cause bleeding).

Carisoprodol (Soma), a centrally acting skeletal muscle relaxant, may cause central nervous system (CNS) side effects of drowsiness and dizziness. For this reason, the client avoids other CNS depressants, such as alcohol, while taking this medication. Driving or other activities requiring mental alertness are also avoided until the client’s reaction to the medication is known. The medication is used to reduce muscle spasticity and pain. Missed doses should be taken if remembered within 1 hour.

Amantadine hydrochloride (Symmetrel) is administered twice a day but the last dose should not be administered near bedtime, since it may cause insomnia in some clients

Folic acid is necessary for red blood cell production, and it is classified as a vitamin and an antianemic. The effectiveness of therapy can be measured by monitoring periodic complete blood count levels, noting particularly the hematocrit level.

Propantheline bromide is an anticholinergic medication that is used as an adjunct for of therapy in peptic ulcer disease. It is also used as an antispasmodic agent. It should be used cautiously with prostatic hypertrophy, because the anticholinergic effects of the medication could cause exacerbation of symptoms, including urinary retention or hesitancy. Other side effects of the medication include constipation, dry mouth, and decreased sweating. Tachycardia is a common cardiovascular side effect.

Since dysphagia is a classic sign of myasthenia gravis exacerbation, observing how a client is able to ingest food is an important assessment. Timing of this medication is of paramount concern.

Isoniazid interacts with foods containing tyramine and histamine, such as tuna and aged cheese. These foods should be avoided. Common manifestations of an interaction include headache, diaphoresis, lightheadedness, and hypotension. The medication should be taken on empty stomach.

Humulin R is a rapid-acting insulin with a peak action of 2 to 4 hours after injection. During the peak action of insulin is when hypoglycemic reactions are most likely to occur.

Clients receiving alteplase (Activase) are at high risk for bleeding and hemorrhage. The nurse needs to assess for overt bleeding and internal bleeding. Vital signs should be closely monitored. The physician should be notified immediately in the event of bleeding.

The client with ARDS often requires mechanical ventilation to manage the respiratory status. The client may develop tachypnea or restlessness or begin to fight (buck) the ventilator. Intravenous sedation is usually tried first to prevent the client from bucking the ventilator, and if that is unsuccessful, a neuromuscular blocking agent such as vecuronium (Norcuron) may be given to paralyze the client.

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