NMNC 1230 Final Exam Study Guide 11

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Central New Mexico Community College *

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1230

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Health Science

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Feb 20, 2024

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NMNC 1230 Final Exam Study Guide The Final Exam is cumulative and includes approximately 25% of content on Nutrition and Elimination concepts. Please see your course agenda for chapters and concepts. The final contains 60 questions of multiple choice, select all that apply, and fill in the blank (dosage). You have 1 hour and 30 minutes to complete the exam. Focus on the prototype drugs in your McCuistion et al (2023) [Pharmacology] assigned reading chapters, the Nursing Process/Clinical Judgement Measurement Model sections, as well as the study guide content below. Chapter 13: Vitamins and Mineral Replacements  vitamin A (use, side effects) Fat soluble vitamin that can cause night blindness with deficient amounts, and can stay stored in the liver for months to years  ferrous sulfate (iron) therapeutic use, pharmacodynamics Mineral needed for proper red blood cell development (and to treat anemia); adequate fluid needed to prevent constipation.  vitamin C (use, pharmacodynamics) A water-soluble vitamin essential for collagen formation and tissue repair; can cause kidney stones with excessive amounts  water soluble vs fat soluble vitamins (pharmacokinetics, pharmacodynamics) Water soluble: Not usually toxic unless taken in excessive amounts; not stored by the body and excreted in the urine. Fat soluble: A, D, E, K. Metabolized and excreted through urine slowly; can be stored in fatty tissue, liver, and muscle and can be toxic if taken in excessive amounts. Chapter 45: Gastrointestinal Drugs  psyllium (bulk laxative) (use, side effects, patient teaching) Electrolyte imbalances, abdominal cramping, flatulence, adverse effect of bowel obstruction if not taken with adequate fluid  ondansetron (serotonin 5-HT3 antagonist) (use, side effects) For postoperative and chemo- and radiation-induced nausea and vomiting. May cause dizziness, drowsiness, agitation, headache, fatigue, malaise, diarrhea, hypotension, urinary retention, fever, and constipation.  promethazine (phenothiazine) contraindications, side effects

Central nervous system (CNS) depression increases with other CNS depressants like alcohol, narcotics, sedative- hypnotics; due to anticholinergic effects this drug is contraindicated with glaucoma.  diarrhea & nonpharmacologic measures Brat diet, toast, apple sauce, This includes use of clear liquids and oral solutions such as Gatorade (for adults) and Pedialyte or Rehydralyte (for children) and IV electrolyte solutions.  diphenoxylate with atropine nursing interventions, patient teaching CNS depressants or sedatives may increase CNS depression such as respiratory depression and hypotension, do not ingest fried food or milk until diarrhea stopped. Check for signs and symptoms of dehydration resulting from persistent diarrhea. Fluid replacement may be necessary. With prolonged diarrhea, check serum electrolytes. Recognize that a drug may need to be withheld if diarrhea continues for more than 48 hours or acute abdominal pain develops. Chapter 46: Antiulcer Drugs  H2 blocker (patient teaching, side effects) Vitamin B-12 deficiency, erectile dysfunction is reversible when discontinued.  proton pump inhibitor (use, drug interactions) May interfere with absorption of digoxin or ampicillin. To treat duodenal ulcers, GERD, esophagitis, dyspepsia, pyrosis, Helicobacter pylori infection, and Zollinger-Ellison syndrome and to prevent NSAID-induced ulcers.  h. pylori pharmacologic treatment A common treatment protocol is the triple therapy of metronidazole (or amoxicillin), omeprazole (or lansoprazole), and clarithromycin (MOC). The drug regimen eradicates more than 90% of peptic ulcers caused by H. pylori. If triple therapy fails to eradicate H. pylori, quadruple therapy using two antibiotics, a PPI, and a bismuth or histamine2 (H2) blocker is recommended. After completion of the treatment regimen, 6 weeks of standard acid suppression—such as H2 blocker therapy—is recommended.  aluminum hydroxide (side effects, nursing interventions) This drug neutralizes acid, and in liquid form is more effective if taken 1-3 hours after meals with a small amount of water; may cause constipation.  magnesium hydroxide (side effects, nursing interventions) This drug is contraindicated with renal disease; labs such as BUN, creatinine, and magnesium should be monitored with excessive use; may cause diarrhea May cause chalky taste, nausea,

vomiting, diarrhea, dehydration, and hypermagnesemia. Hypermagnesemia can result from continuous use of magnesium salts, causing symptoms such as drowsiness, weakness, paralysis, complete heart block, hypotension, flush, and respiratory depression . Monitor fluid intake and output, signs and symptoms of fluid and electrolyte imbalances that may result from watery stools. Habitual use of laxatives can cause fluid volume deficit, electrolyte losses, and loss of the urge to defecate.  antacid medication administration (mechanism of action, how to administer) Antacids are given orally as a chewable or liquid .  nonpharmacologic treatment/patient teaching for GERD Encouraging small, frequent fluids or meals, Avoiding tobacco products, Lying down with HOB elevated, Taking NSAIDS with food Review of Content from Weeks 2 – 11 Chapter 1: CJMM  Identifying steps within the Clinical Judgement Measurement Model  c. Recognize Cues [Assessment]1  b. Analyze Cues [Analysis] 2  d. Prioritize Hypothesis [Analysis]3  a. Generate Solutions [Planning]4  f. Take Action [Intervention]5  e. Evaluate Outcomes [Evaluation]6 Chapter 3: Pharmacokinetics and Pharmacodynamics  pharmacodynamic interaction definitions: additive effect, synergistic effect, antagonistic effect Chapter 6: Pediatric Considerations (know these)  pediatric considerations with med administration (pharmacokinetics & pharmacodynamics) Chapter 7: Drug Therapy in Older Adults (know these)  geriatric considerations with med administration (pharmacokinetics & pharmacodynamics) Chapter 9: Safety & Quality

 high alert drugs (know examples)  patient’s rights/rights of medication administration Right dose, route, time, medication, documentation, patient. Chapter 10: Drug Administration  drug administration: forms and routes Chapter 13: Vitamin and Mineral Replacement (see first page) Chapter 15: Adrenergic Agonists and Antagonists  adrenergic agonists and antagonists: side effects and patient teaching Ø Therapeutic use: o Improve heart pressure o Improve breathing pattern o Improve cardiac output Ø Side effects: o Rapid heart rate, palpitations, rash, itching, flushing, chest pain, irregular heartbeat, vomiting, numbness of fingers and toes. Hypertension, restlessness, tremors, dysrhythmia, dizziness, urinary retention, nausea, dyspnea, pulmonary edema. REPORT TO A HEALTH CARE PROVIDER because dose may require adjustment Chapter 17: Stimulants  methylphenidate (amphetamine-like): patient teaching Chapter 19: Anti-seizure Drugs  status epilepticus and seizure/epilepsy pharmacotherapy Phenytoin (Hydantoin Anticonvulsant) Chapter 21: Drugs for Neuromuscular Disorders and Muscle Spasms  cyclobenzaprine (skeletal muscle relaxant) indications/use and side effects Chapter 22: Antipsychotics and Anxiolytics haloperidol/antipsychotic: adverse effects, assessment with medication use  Therapeutic Effects/Uses  To treat acute psychoses, schizophrenia, Tourette syndrome

 Mechanism of Action: Alters the effect of dopamine on the CNS; mechanism for antipsychotics is unknown.   Side Effects  Drowsiness, edema, headache, blurred vision, depression, confusion, euphoria,  cataracts, lethargy, tremor, dry mouth, constipation, weight gain/loss, restlessness, hyperhidrosis, erectile dysfunction, urinary retention.   Adverse effects:  Tachycardia, orthostatic hypotension, EPS, hyper/hypoglycemia, hyponatremia,  seizures, retinopathy, osteopenia.  Life-threatening: Laryngeal edema, bronchospasm, dysrhythmias, eosinophilia, aplastic anemia, hemolytic anemia, agranulocytosis, leukopenia, neutropenia, thrombocytopenia, pancytopenia, hepatic failure, NMS, rhabdomyolysis Chapter 23: Antidepressants and Mood Stabilizers venlafaxine (SNRI) use, side effects, adverse effects  Use: Depression & Pain Generalized anxiety disorder Social anxiety disorder  Increases availability at the synapse.   Side effects: Drowsiness, dizziness, insomnia, headache, amnesia, blurred vision, erectile/ejaculation dysfunction.  Adverse effects: Hypertension, orthostatic hypotension, tachycardia, seizures, NMS, suicidal ideation.   MAOIs Monoamine oxidase enzyme inactivates norepinephrine, dopamine, epinephrine, and serotonin. Chapter 25: Analgesics  opioid analgesics- indications for use, nursing assessment & interventions with use 1. Morphine (Opioid)

 indications for use for pain: to relieve moderate to severe pain.  Common side effects (opioids and non-opioids): anorexia, dry mouth, nausea, abdominal pain, diarrhea, Constipation, flatulence, fever, drowsiness, dizziness, agitation, anxiety, dysgeusia, confusion, depression, urinary retention, rash, blurred vision, miosis, weakness, flushing, euphoria, peripheral edema, paresthesia, diaphoresis, pruritus, infection, back pain, insomnia, erectile dysfunction.  Adverse effects (opioids and non-opioids): orthostatic hypotension, bradycardia, tachycardia, palpitations, seizures, ileus, psychological dependence, dyspnea. Life threatening: respiratory depression, anemia, leukopenia, thrombocytopenia, pulmonary edema, GI obstruction, dysrhythmias  Patient teaching on max dosage (acetaminophen): - administer morphine before pain reaches its peak to maximize effectiveness - monitor vital signs at frequent intervals to detect respiratory changes and hypotension. Fewer than 10 respirations permanent can indicate respiratory distress. -Record the patient's urine output because urinary retention is a side effect of morphine. Urine output should be at least 600 milliliters per day. -Check bowel sounds for decreased peristalsis; constipation is a side effect of morphine. A dietary change or mild laxative might be needed. - Check for pupil changes in reaction. Pinpoint pupils can indicate morphine overdose. - Have naloxone available as an antidote to reverse respiratory depression if morphine overdose occurs. -Validate the dose of morphine before administration. -Encourage patients not to use alcohol or central nervous system depressants with any opioid analgesic such as morphine. -suggest non pharmacologic measures to relieve pain as the patient recuperates from surgery. -Alert patients that with continuous use, or opioids such as morphine can become a substance use disorder. -Encourage patients to report dizziness while taking morphine - teach patients to report difficulty in breathing, blurred vision, and headaches.  opioid reversal/antagonist Chapter 28: Tetracyclines, Glycylcyclines, Aminoglycosides, and Fluoroquinolones  trough and peak drug serum levels: indications for lab

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