The nurse would assess which laboratory value to determine the effectiveness of intravenous heparin?
A) Complete blood count (CBC)
B) Activated partial thromboplastin time (aPTT)
C) Prothrombin time (PT)
D) BUN
B) Activated partial thromboplastin time (aPTT)
Heparin dosing is based on aPTT results. The PT is reflective of warfarin's anticoagulant effect.
A patient who has been anticoagulated with warfarin (Coumadin) is admitted with gastrointestinal bleeding. The nurse will anticipate administering which substance?
A) vitamin E
B) vitamin K
C) protamine sulfate
D) calcium gluconate
B) vitamin K
-Vitamin K is the antagonist for warfarin.
The nurse understands that a patient's international normalized ratio (INR) value of 2.5 means that
A) the patient is not receiving enough warfarin for a therapeutic effect.
B) the patient's warfarin dose is therapeutic.
C) the patient is not receiving en
B) the patient's warfarin dose is therapeutic.
-A therapeutic INR is 2 to 3
Which statement when made by the patient indicates deficient knowledge regarding warfarin?
A) "I will avoid contact sports."
B) "I will take my medication in the early evening each day."
C) "I will increase the dark green leafy vegetables in my diet."
D)
C) "I will increase the dark green leafy vegetables in my diet."
Dark green leafy vegetables are rich in vitamin K, which would antagonize the effects of warfarin. Therefore, it is important to maintain a consistent daily intake of vitamin K and avoid eat
Which of the following medications has antiplatelet properties?
A) clopidogrel
B) enoxaparin
C) heparin
D) alteplase
A) clopidogrel
-Clopidogrel (Plavix) is an antiplatelet drug indicated for thrombus prevention associated with strokes and myocardial infarction. Enoxaparin and heparin are anticoagulants. Alteplase is a thrombolytic drug.
While preparing a patient with acute chest pain for an emergency angioplasty, the nurse would anticipate administering which of the following medications to prevent platelet aggregation?
A) tirofiban (Aggrastat)
B) protamine sulfate
C) warfarin (Coumadin)
A) tirofiban (Aggrastat)
Tirofiban is a glycoprotein IIbIIIa inhibitor that blocks the enzyme essential for platelet aggregation. This is given to prevent the formation of further clots and is faster acting than warfarin. Protamine sulfate is the antagoni
Enoxaparin sodium (Lovenox) is an anticoagulant used to prevent and treat deep vein thrombosis and pulmonary embolism. This drug is in which drug group?
A) Low molecular weight heparin
B) Oral anticoagulant
C) Glycoprotein IIb/IIIa inhibitor
D) Thrombolyt
A) Low molecular weight heparin
Enoxaparin is a low molecular weight heparin. The other answers are incorrect.
The patient asks what the difference is between dalteparin (Fragmin) and heparin. What is the nurse's best response?
A) "There is really no difference, but dalteparin is preferred because it is less expensive."
B) "Dalteparin is a low molecular weight hep
B) "Dalteparin is a low molecular weight heparin that has a more predictable anticoagulant effect."
A low molecular weight heparin is more predictable in its effect than regular heparin. Dalteparin is more expensive than heparin and is dosed based upon th
Before emergency surgery, the nurse would anticipate administering which medication to a patient receiving heparin?
A) vitamin K
B) vitamin E
C) phenytoin
D) protamine sulfate
D) protamine sulfate
Protamine sulfate binds with heparin in the bloodstream to inactivate it and thus reverse its effect.
Nursing care for a patient receiving alteplase (Activase) would include which action? (Select all that apply.)
A) Record vital signs and report changes.
B) Observe for signs and symptoms of bleeding.
C) Monitor liver enzymes.
D) Assess for cardiac dysrhyt
A) Record vital signs and report changes.
B) Observe for signs and symptom
D) Assess for cardiac dysrhythmias.
-Alteplase can cause bleeding as well as cardiac dysrhythmias. Vital sign changes can alert the nurse to these complications. Alteplase does not
A patient who is taking an anticoagulant requests an aspirin for headache relief. What is the nurse's best action?
A) Administer 650 mg of acetylsalicylic acid (ASA), and reassess pain in 30 minutes.
B) Take advantage of a teachable moment to inform the p
B) Take advantage of a teachable moment to inform the patient of potential drug interactions with anticoagulants.
-Patients taking an anticoagulant should not use medications that would further increase the risk of bleeding.
A patient is started on oral anticoagulant therapy while still receiving intravenous heparin. The patient is concerned about risk for bleeding. What is the nurse's best response?
A) "Your concern is valid in that you are at an increased risk for bleeding,
B) "It usually takes 4 to 5 days to achieve a full therapeutic effect for warfarin, so the heparin is continued to help prevent blood clots until the warfarin is working up to speed."
Warfarin works by decreasing the production of clotting factors. Howeve
The nurse evaluates understanding of discharge instructions regarding warfarin (Coumadin) when the patient states
A) "I will double my dose if I forget to take it the day before."
B) "I should keep taking ibuprofen for my arthritis."
C) "I should decrease
D) "I should use a soft toothbrush for dental hygiene."
The patient should reduce the risk of bleeding, such as using a soft toothbrush. The other choices are
Before administering alteplase (Activase), it is important for the nurse to perform which action?
A) Perform all necessary venipunctures.
B) Administer aminocaproic acid (Amicar) to prevent adverse reactions.
C) Have the patient void.
D) Assess for allerg
A) Perform all necessary venipunctures.
Activase is a thrombolytic drug that can interfere with the body's clotting ability. Therefore all invasive procedures should be completed before administering this drug.
The nurse formulates a plan of care for a patient receiving heparin based upon which nursing diagnosis?
A) Excess fluid volume
B) Chronic pain
C) Risk for injury
D) Impaired urinary elimination
C) Risk for injury
The patient receiving heparin is at risk for injury secondary to increased risk of bleeding.
The nurse recognizes that patient teaching regarding warfarin (Coumadin) has been successful when the patient acknowledges an increased risk of bleeding with concurrent use of which herbal product? (Select all that apply.)
A) Garlic
B) Ginkgo
C) Ginseng
D
A) Garlic
B) Ginkgo
C) Ginseng
-Garlic, ginkgo, and ginseng alter blood coagulation and may increase the risk of bleeding when given concurrently with oral anticoagulants. Glucosamine does not affect coagulation.
While observing a patient self-administer enoxaparin (Lovenox), the nurse identifies the need for further teaching when the patient
A) does not aspirate prior to injecting the medication.
B) massages the site after administration of the medication.
C) adm
B) massages the site after administration of the medication.
It is not recommended to massage the area of injection of anticoagulants due to the increased risk of hematoma formation.
Which statement will indicate to the nurse that the patient understands the discharge instructions regarding cholestyramine (Questran)?
A) "I will take Questran 1 hour before my other medications."
B) "I will increase fiber in my diet."
C) "I will weigh m
B) "I will increase fiber in my diet."
Cholestyramine can cause constipation; thus increasing fiber in diet is appropriate. All other drugs should be taken 1 hour before or 4 hours after cholestyramine to facilitate proper absorption.
The nurse plans which of the following interventions to decrease the flushing reaction of niacin?
A) Administer niacin with an antacid.
B) Administer aspirin 30 minutes before nicotinic acid.
C) Administer diphenhydramine hydrochloride (Benadryl) with the
B) Administer aspirin 30 minutes before nicotinic acid.
Administration of an antiinflammatory drug such as aspirin has been shown to decrease the flushing reaction associated with niacin.
HMG-CoA reductase inhibitors (statins) are generally administered at which time?
A) On an empty stomach
B) In the evening
C) With breakfast
D) With an antacid
B) In the evening
The liver produces the majority of cholesterol during the night. Thus statin drugs, which work to decrease this synthesis, are generally administered during the evening so that blood levels are highest coinciding with this production.
Which are common side effects of fenofibrate (Tricor), a fibric acid derivative? (Select all that apply.)
A) Nausea, vomiting, and abdominal pain
B) Increase in gallstone formation
C) Impotence
D) Constipation
A) Nausea, vomiting, and abdominal pain
B) Increase in gallstone formation
C) Impotence
Diarrhea, not constipation, is a common side effect of fibric acid derivatives. All of the other side effects listed can occur with fenofibrate.
Discharge teaching for a patient receiving an antilipemic medication would include
A) "This medication will take over for other interventions you have been trying to decrease your cholesterol."
B) "It is important for you to double your dose if you miss o
D) "Continue your exercise program, and maintain a diet high in omega-3 fatty acids."
Antilipemic medications are an addition to, not a replacement of, the therapeutic regimen used to decrease serum cholesterol.
What is the mechanism of action of ezetimibe (Zetia)?
A) Inhibiting absorption of dietary and biliary cholesterol in the small intestine
B) Inhibiting the biosynthesis of cholesterol in the liver
C) Binding to bile in the intestinal tract, inhibiting its
A) Inhibiting absorption of dietary and biliary cholesterol in the small intestine
Ezetimibe is the newest type of antilipemic medication, working by inhibiting the absorption of cholesterol in the small intestine.
Cholestyramine (Questran) decreases lipid levels by
A) inhibiting absorption of dietary cholesterol in the small intestine.
B) binding to bile in the intestinal tract, forming an insoluble complex that is excreted in the feces.
C) inhibiting the biosynthe
B) binding to bile in the intestinal tract, forming an insoluble complex that is excreted in the feces.
Cholestyramine is an anion exchange resin that binds to bile to form an insoluble complex that is excreted. The liver must then use cholesterol to synt
Which statement, made by the patient, demonstrates a knowledge deficit regarding colestipol (Colestid)?
A) "The medication may cause constipation, so I will increase fluid and fiber in my diet."
B) "I should take this medication 1 hour after or 4 hours be
D) "I should mix and stir the powder in as small an amount of fluid as possible in order to maintain potency of the medication."
Colestipol is a powder that must be well diluted in fluids before administration to avoid esophageal irritation or obstruction
Atorvastatin (Lipitor) decreases lipid levels by
A) inhibiting absorption of dietary cholesterol in the small intestine.
B) binding to bile in the intestinal tract, forming an insoluble complex that is excreted in the feces.
C) stimulating the biliary sys
D) inhibiting HMG-CoA reductase, the enzyme responsible for the biosynthesis of cholesterol in the liver.
Atorvastatin (Lipitor) is an HMG-CoA reductase inhibitor, decreasing the synthesis of cholesterol in the liver.
Which test will the nurse use to assess for adverse reactions to HMG-CoA reductase inhibitors?
A) Serum cholesterol levels
B) Liver function tests
C) Serum electrolytes
D) CBC
B) Liver function tests
HMG-CoA reductase inhibitors can cause hepatic toxicity, thus it is necessary to monitor liver function tests every 3 months for the first year of treatment.
Discharge teaching for a patient receiving simvastatin (Zocor) should include the importance of reporting which symptoms that might indicate a serious adverse reaction to the medication?
A) Muscle pain
B) Headache
C) Nausea and vomiting
D) Fatigue
A) Muscle pain
Muscle pain must be reported because it could signify an uncommon but serious side effect of rhabdomyolysis associated with statin drugs.
The nurse would question an order for simvastatin (Zocor) in a patient with which condition?
A) Leukemia
B) Diabetes
C) Hepatic disease
D) COPD
C) Hepatic disease
Simvastatin (Zocor) can cause an increase in liver enzymes and thus should not be used in patients with preexisting liver disease.
A patient with elevated triglyceride levels unresponsive to HMG-CoA reductase inhibitors will most likely be prescribed which drug?
A) gemfibrozil (Lopid)
B) cholestyramine (Questran)
C) colestipol (Colestid)
D) simvastatin (Zocor)
A) gemfibrozil (Lopid)
Gemfibrozil, a fibric acid derivative, promotes catabolism of triglyceride-rich lipoproteins.
The nurse would question an order for colesevelam (Welchol) in a patient with which condition?
A) Renal disease
B) Complete bowel obstruction
C) Glaucoma
D) Hepatic disease
B) Complete bowel obstruction
Colesevelam (Welchol) binds with bile in the intestinal tract to form an insoluble complex. It can also bind to other substances and lead to intestinal obstruction.
The nurse will assess a patient receiving gemfibrozil (Lopid) and warfarin (Coumadin) for which adverse effect?
A) Increased risk of clotting
B) Increased risk of vitamin K toxicity
C) Increased risk of bleeding
D) Deep vein thrombosis
A) Increased risk of clotting
Gemfibrozil can bind with vitamin K in the intestinal tract, reducing vitamin K absorption. Since vitamin K is the antidote for warfarin, a lack of vitamin K increases the anticoagulant effect of warfarin and thus the risk of
When reviewing a patient's medication regimen before discharge, the patient asks why he is taking pyridoxine when he is already taking isoniazid to treat tuberculosis. What is the nurse's best response?
A) "Pyridoxine is another antitubercular drug that w
C) "Pyridoxine will help prevent numbness and tingling that can occur secondary to the isoniazid."
Isoniazid can cause neurotoxicity. Pyridoxine, vitamin B6, is the drug of choice to prevent this adverse reaction. It is not an antiinfective drug and thus
A patient receiving rifampin must be told that
A) a nonharmful side effect of the drug is red-orange discoloration of urine, sweat, and tears.
B) oral contraception is the preferred method of birth control when using rifampin.
C) peripheral neuropathy is
A) a nonharmful side effect of the drug is red-orange discoloration of urine, sweat, and tears.
Red-orange discoloration of body fluids is a common side effect of rifampin, but it is not harmful. Rifampin does not cause peripheral neuropathies (isoniazid
Which statement by your patient leads you to believe that she has understood the teaching you have done regarding ethambutol (Myambutol)?
A) "Dizziness, drowsiness, and decreased urinary output are common with this drug, but they will subside over time.
C) "I will need to have my eyes checked periodically while I am taking this drug."
Ethambutol can cause optic neuritis. Ophthalmologic examinations should be performed periodically to assess visual acuity.
The nurse will teach patients taking rifampin and INH prophylactically secondary to tuberculosis exposure that
A) these drugs will only need to be taken for 7 to 10 days.
B) INH may decrease serum glucose in susceptible people.
C) oral contraceptives beco
C) oral contraceptives become ineffective when given with rifampin.
Women taking oral contraceptives who are prescribed rifampin must be switched to another form of birth control because oral contraceptives become ineffective when given with rifampin. The
When assessing for adverse reactions to Rifamate (combination isoniazid and rifampin), the nurse would monitor which laboratory values? (Select all that apply.)
A) Liver function tests
B) CBC
C) Sputum cultures
D) Uric acid levels
A) Liver function tests
B) CBC
This drug can lead to impairment of liver function as well as hematologic disorders. Assessment of sputum cultures confirms the diagnosis but is not related to adverse effects. The drug does not affect uric acid levels.
The nurse will teach patients that antacids are effective in treatment of hyperacidity because they:
A) neutralize gastric acid.
B) decrease stomach motility.
C) decrease gastric pH.
D) decrease duodenal pH
A) neutralize gastric acid.
Antacids work by neutralizing gastric acid, which would cause an increase in pH. They do not affect gastric motility.
The nurse will monitor for which adverse reaction to aluminum-containing antacids such as aluminum hydroxide (Amphojel)?
A) Diarrhea
B) Constipation
C) Gastrointestinal upset
D) Fluid retention
B) Constipation
Aluminum- and calcium-containing antacids cause constipation, magnesium-containing antacids cause diarrhea, and sodium-containing antacids cause sodium and fluid retention.
Which type of antacids will the nurse most likely question in an order for a patient with chronic renal failure?
A) Aluminum-containing antacids
B) Calcium-containing antacids
C) Magnesium-containing antacids
D) Sodium-containing antacids
C) Magnesium-containing antacids
Magnesium-containing antacids can cause hypermagnesemia in patients with chronic renal failure. Aluminum-containing antacids may be used as a phosphate binder in patients with chronic renal failure. Sodium and aluminum-con
The nurse will monitor a patient using sodium bicarbonate to treat gastric hyperacidity for signs and symptoms of
A) metabolic alkalosis.
B) metabolic acidosis.
C) hyperkalemia.
D) hypercalcemia.
A) metabolic alkalosis.
Solutions containing sodium bicarbonate (a base) can cause metabolic alkalosis. Serum K and serum calcium would decrease with alkalosis, not increase.
Which nursing diagnosis is appropriate for a patient receiving famotidine (Pepcid)?
A) Risk for infection related to immunosuppression
B) Risk for injury related to thrombocytopenia
C) Impaired urinary elimination related to retention
D) Ineffective tissu
B) Risk for injury related to thrombocytopenia
A serious side effect of famotidine is thrombocytopenia, which is manifested by a decrease in platelet count and an increased risk of bleeding.
Histamine2-receptor antagonists
A) compete with histamine for binding sites on the parietal cells.
B) irreversibly bind to H+/K+ATPase.
C) cause a decrease in stomach pH.
D) decrease signs and symptoms of allergies related to histamine release.
A) compete with histamine for binding sites on the parietal cells.
Histamine receptor blocking drugs decrease gastric acid by competing with histamine for binding sites on the parietal cells.
Which statement demonstrates understanding of patient teaching regarding the use of histamine2-receptor antagonists?
A) "Since I am taking this medication, it is OK for me to eat spicy foods."
B) "Smoking decreases the effects of this medication, so I sho
B) "Smoking decreases the effects of this medication, so I should look into cessation programs."
Patients taking histamine2-receptor blocking drugs should avoid spicy foods, extremes in temperatures, alcohol, and smoking. They should also increase bulk an
Proton pump inhibitors
A) compete with histamine for binding sites on the parietal cells.
B) irreversibly bind to H+/K+ATPase.
C) cause a decrease in stomach pH.
D) cannot be used to treat erosive esophagitis.
B) irreversibly bind to H+/K+ATPase.
Proton pump inhibitors work to block the final step in the acid-secreting mechanisms of the proton pump. They do this by irreversibly binding to H+/K+ATPase, the enzyme for this step.
Because proton pump inhibitors have the ability to almost totally inhibit gastric acid secretion, the use of the drugs can lead to
A) gastric ulcer formation.
B) GERD.
C) achlorhydria.
D) diverticulosis.
C) achlorhydria.
Because proton pump inhibitors stop the final step of acid secretion, they can block up to 90% of acid secretion, leading to achlorhydria (without acid).
The nurse would teach a patient prescribed simethicone (Gas-X) to avoid which substance(s)?
A) Antacids
B) Dairy products
C) Carbonated beverages
D) Histamine2-receptor antagonists
C) Carbonated beverages
Simethicone is used to decrease gas and belching, both of which can be aggravated or caused by ingesting carbonated beverages. It may be given in combination with other medications used to decrease acidity.
Sucralfate (Carafate) achieves a therapeutic effect by
A) neutralizing gastric acid.
B) enhancing gastric absorption.
C) forming a protective barrier over the gastric mucosa.
D) inhibiting gastric acid secretion.
C) forming a protective barrier over the gastric mucosa.
Sucralfate has a local effect only on the gastric mucosa. It forms a pastelike substance in the stomach, which adheres to the gastric lining, protecting against adverse effects related to gastric ac
Metoclopramide (Reglan) is useful to treat postoperative nausea and vomiting because it
A) decreases mobility in the gastrointestinal tract.
B) decreases chemoreceptor stimulation.
C) improves the body's response to analgesia.
D) promotes motility in the
D) promotes motility in the small intestine.
Metoclopramide works by increasing gastrointestinal motility in the small intestine, thus minimizing gastric distention and accompanying stimulation of the vomiting center.
When planning administration of antiemetic medications to a patient, the nurse is aware that combination therapy is preferred because
A) the risk of constipation is decreased.
B) lower doses of medication are cost-effective.
C) different vomiting pathways
C) different vomiting pathways are blocked.
Combining antiemetic drugs from various categories allows the blocking of the vomiting center and chemoreceptor trigger zone through different pathways, thus enhancing the antiemetic effect.
In developing a plan of care for a patient receiving an antihistamine antiemetic drug, which nursing diagnosis would be of highest priority?
A) Deficient knowledge regarding medication administration
B) Deficient fluid volume related to nausea and vomitin
B) Deficient fluid volume related to nausea and vomiting
Although all of the options are appropriate nursing diagnoses, fluid volume deficit is the highest priority because it has the highest associated mortality rate. Although a fall or injury could also
A patient receiving an anticholinergic drug to treat nausea and vomiting should be taught to expect which side effect?
A) Diarrhea
B) Lacrimation
C) Dry mouth
D) Bradycardia
C) Dry mouth
Anticholinergic drugs block the parasympathetic nervous system, which causes the body to "rest and digest." Blocking of these effects leads to constipation, urinary retention, and decreased secretions (dry mouth).
Which drug works by blocking serotonin in the gastrointestinal tract, vomiting center, and chemoreceptor trigger zone (CTZ)?
A) metoclopramide (Reglan)
B) meclizine (Antivert)
C) droperidol (Inapsine)
D) ondansetron (Zofran)
D) ondansetron (Zofran)
Ondansetron is a serotonin blocker. Metoclopramide is a prokinetic drug, meclizine is an antihistamine, and droperidol is an antidopaminergic drug.
Before administering the anticholinergic drug scopolamine, the nurse would be careful to assess the patient for a history of which condition?
A) Glaucoma
B) Hyperthyroidism
C) Rheumatoid arthritis
D) Gastroenteritis
A) Glaucoma
Anticholinergic drugs are contraindicated in patients with glaucoma. These drugs can cause pupillary dilation, which can obstruct the flow of aqueous humor and increase intraocular pressure.
The nurse plans to administer 50 mg diphenhydramine (Benadryl) intravenously
A) diluted in 50 mL normal saline over 30 minutes.
B) undiluted over 1 minute.
C) diluted in 100 mL D5W over 20 minutes.
D) undiluted over 2 minutes.
D) undiluted over 2 minutes.
Diphenhydramine should be administered undiluted at a rate of 25 mg/min.
The nurse would expect to teach a patient about which antiemetic commonly used to prevent motion sickness?
A) scopolamine (Transderm-Scop)
B) Ddoperidol (Inapsine)
C) prochlorperazine (Compazine)
D) metoclopramide (Reglan)
A) scopolamine (Transderm-Scop)
Scopolamine blocks the binding of acetylcholine with cholinergic receptors in the inner ear, an imbalance of which is a common cause of motion sickness.
Antidopaminergic-like drugs are useful to treat not only nausea and vomiting but which other conditions? (Select all that apply.)
A) Anxiety
B) Seizures
C) Intractable hiccups
D) Schizophrenia
A) Anxiety
C) Intractable hiccups
D) Schizophrenia
Antidopaminergic drugs are used to treat psychotic disorders such as mania and schizophrenia, their associated anxiety, intractable hiccups, and nausea and vomiting.
The nurse would anticipate administering which medication to a patient suffering with nausea and vomiting not relieved by first-line antiemetic drugs?
A) prochlorperazine (Compazine)
B) metoclopramide (Reglan)
C) dronabinol (Marinol)
D) phosphorated carbo
C) dronabinol (Marinol)
Dronabinol is the active ingredient of marijuana. It has been approved by the FDA as a second-line drug to treat nausea and vomiting related to cancer chemotherapy.
When planning to administer metoclopramide (Reglan), the nurse is aware that this drug must be given:
A) with food to decrease gastrointestinal upset.
B) every 6 hours around the clock.
C) 30 minutes before meals and at bedtime.
D) with a full glass of wa
C) 30 minutes before meals and at bedtime.
Metoclopramide should be administered 30 minutes before meals and at bedtime. Administering the medication before meals allows time for onset to increase gastrointestinal motility before food ingestion, thus decr
Which statement regarding antiemetic medications, if made by the patient, indicates the need for further patient teaching?
A) "I will not drive while I am taking these medications because they may cause drowsiness."
B) "I may take Tylenol to treat the hea
C) "I will apply the scopolamine patches to rotating sites on my arms."
Transdermal scopolamine patches should be applied to nonirritated areas behind the ear, not on the arms.
When assessing a patient with irritable bowel syndrome (IBS), the nurse identifies which as a factor related to development of IBS?
A) Gastroesophageal reflux disease
B) Chronic diarrhea
C) History of bulimia as a teenager
D) High-stress lifestyle
D) High-stress lifestyle
Stress is one of the most common associated factors for development of IBS.
Lactulose, a hyperosmotic laxative, also functions to
A) decrease peripheral edema.
B) correct sodium imbalances.
C) reduce ammonia levels.
D) alleviate galactose intolerance.
C) reduce ammonia levels.
Lactulose reduces blood ammonia levels by forcing ammonia from the blood into the colon. It is useful in treating patients with hepatic encephalopathy.
Milk of Magnesia alleviates constipation by which action?
A) Increasing water absorption into the colon
B) Lubricating the passage of stool
C) Increasing bulk within the colon
D) Stimulating nerves that regulate defecation
A) Increasing water absorption into the colon
Milk of Magnesia is a saline laxative that increases osmotic pressure to draw water into the colon.
The mechanism of action of diphenoxylate (Lomotil) is
A) an increase in intestinal excretion of water.
B) an increase in intestinal motility.
C) a decrease in peristalsis in the intestinal wall.
D) a decrease in the reabsorption of water in the bowel.
C) a decrease in peristalsis in the intestinal wall.
Diphenoxylate acts on the smooth muscle of the intestinal tract to inhibit gastrointestinal motility and excessive propulsion of the gastrointestinal tract (peristalsis).
Bismuth subsalicylate (Pepto-Bismol), as an adsorbent, has which mechanism of action?
A) Decreased gastrointestinal motility
B) Decreased gastric secretions
C) Increased fluid absorption
D) Binding to diarrhea-causing bacteria for excretion
D) Binding to diarrhea-causing bacteria for excretion
Adsorbent antidiarrheal medications bind to diarrhea-causing bacteria to form a nonabsorbable complex, which is then excreted in the stool.
To avoid fecal impaction, psyllium (Metamucil) should be administered with at least how many ounces of fluid?
A) 4
B) 6
C) 8
D) 10
C) 8
Bulk-forming laxatives such as psyllium must be given with at least 8 ounces of liquid plus additional liquid each day to avoid intestinal impaction.
Anticoagulants a.k.a. antithrombics
Drugs
warfarin (Coumadin); LMWH: enoxaparin (Lovenox), dalteparin (Fragmin), tinzaparin (Innohep); heparin, lepirudin (Refludan), argatroban (Argatroban), bivalirudin (Angiomax)
Anticoagulants a.k.a. antithrombics
Action
prevent formation of clot/thrombus by interfering with clotting cascade; does NOT lyse a clot that has already been formed
HEPARIN: binds to antithrombin III and shuts of activated factor II, X, IX
LMWH (low molecular weight heparin): binds to factor X
WA
Anticoagulants a.k.a. antithrombics
Indications
MI, unstable angina, atrial fibrilation, use of indwelling devices, conditions where blood flow is slowed or may pool, prolonged immobilization
Anticoagulants a.k.a. antithrombics
Contraindications
drug allergy, acute bleeding process, thrombocytopenia; warfarin: pregnancy; LMWHs: indwelling epidural catheter
Anticoagulants a.k.a. antithrombics
Side Effects
bleeding (localized or systemic); hematoma;
HEPARIN: heparin-induced thrombocytopenia (HIT syndrome);
WARFARIN: skin necrosis, "purple toes" syndrome
TOXICITY: hematuria, melena, petechiae, ecchymoses, gum/mucous membrane bleeding
heparin antidote: protam
Anticoagulants a.k.a. antithrombics
interactions
enzyme inhibition of metabolism; displacement of drug from inactive protein-binding sites; decrease in vitamin K absorption or synthesis; alteration in platelet count/activity
WARFARIN: drugs- amiodarone, fluconazole, erythromycin, metronidazole, sulfonam
Anticoagulants a.k.a. antithrombics
interventions
enzyme inhibition of metabolism; displacement of drug from inactive protein-binding sites; decrease in vitamin K absorption or synthesis; alteration in platelet count/activity
WARFARIN: drugs- amiodarone, fluconazole, erythromycin, metronidazole, sulfonam
Antiplatelets
Drugs
aspirin, clopidogrel (Plavix), eptifibatide (Integrillin)
Antifibrinolytics
drugs
aminocaproic acid (Amicar), desmopressin (DDAVP)
Thrombolytics
drugs
alteplase (Activase)
Antituberculars
drugs
First-line drugs: ethambutol (Myambutol), isoniazid (INH), pyrazinamide (PZA), rifabutin, rifampin (Rifadin), rifapentine (Priftin), streptomycin
Second-line drugs: amikacin, capreomycin, cycloserine, ethionamide, kanamycin, levofloxacin, ofloxacin, para-
Antituberculars
action
inhibit protein synthesis, cell wall synthesis or other mechanisms; reduce cough -> reduce transmission
Antituberculars
indications
prophylaxis or treatment of pulmonary and extrapulmonary TB
Antituberculars
contradictions
drug allergy; renal or liver dysfunction; chronic alcohol use � ISONIAZID: hepatic injury, acute liver disease � PYRANIZAMIDE: hepatic disease, gout � CYCLOSERINE: epilepsy, mental illness � ETHAMBUTOL: optic neuritis � STREPTOMYCIN: pregnancy
Antituberculars
side effects
ESONIAZID: pyriidoxine deficiency, peripheral neuropathy, hepatotoxicity, optic neuritis, visual disturbances, hyperglycemia � ETHAMBUTOL: retrobulbar neuritis, blindness � PYRAZINAMIDE: hepatotoxicity, hyperuricemia � AMIKACIN/ CAPREOMYCIN: ototoxicity,
Antituberculars
interactions
false positive reading on urnie glucose test; increase serum liver function enzymes � aminosalicylate: probenecid, salicylates � isoniazid: antacids, cycloserine, ethionamide, rifampin � streptomycin: nephrotoxic/neurotoxic drugs, oral anticoagulants � ri
Antituberculars
intervention
given in combination other TB drugs b/c of possibility for resistance; PT education on adherence to drug regime b/c treatment may take up to 24 months; take drugs as ordered at same time each day; take with food to minimize GI upset; monitor for s/s of li
Antacids
drugs
aluminum, magnesium, calcium, and sodium salts
Antacids
actions
neutralize gastric acidity, but do not prevent overproduction of acid; promote gastic mucosal defensive mechanisms
Antacids
indications
relief of symptoms of peptic ulcer, gastritis, gastric hyperacidity, heartburn
Antacids
contraindications
allergy, renal failure, electrolyte imbalances (from the accumulation of electrolytes in antacid itself), GI obstruction (may stimulate motility when it is undesirable)
Antacids
side effects
systemic alkalosis esp. w/ sodium bicarbonate
Magnesium: diarrhea
Aluminum: constipation
Calcium: constipation, kidney stones, rebound hyperacidity, hypercalcemia, hypophosphatemia, milk-alkali syndrome
Antacids
interactions
Types of Interactions: adsorption- reduces avility of other drugs to be absorbed into the body � chelation- chemical inactivation of other drugs that produces insoluble complexes � increased stomach pH- increases absorption of basic drugs, decreases absor
Antacids
interventions
take interacting druks at least 1-2 hours before or after antacid; take antacids 2 hours before or after quinolone antibiotic b/c antacids decrease absorption by over 50%; safe for pregancy a long as not take in high doses or for prolonged periods of time
H2 Receptor Antagonists
drugs
cimetidine (Tagamet), ranitidine (Zantac), famotidine (Pepcid)
H2 Receptor Antagonists
action
block H2 receptors acid-producing parietal cells, making them less responsive to histamin, ACh, and gastrin causing reduction in H+ ion secretion which results in increase of pH of the stomach; reduce but do not completely abolish acid secretion
H2 Receptor Antagonists
indications
GERD, PUD, erosive esophagitis, adjunct therapy in control of upper GI tract bleeding, treatment of pathologic gastric hypersecretory conditions (Zollinger-Ellison syndrome), stress ulcer prophylaxis
H2 Receptor Antagonists
contraindication
drug allergy, liver/kidney dysfunction
H2 Receptor Antagonists
side effects
hypotension, headache, lethargy, confusion, depression, hallucinations, slurred speech, agitation, increased prolactin secretion, gynecomastia (w/ cimetidine), diarrhea, nausea, abdomina crmps, impotence, increased BUN/ creatinine levels, elevated liver e
H2 Receptor Antagonists
interactions
can raise blood concentrations of certtain drugs b/c of its binding to hepatic enxymes especially in drugs with narrow theraputic range like theophylline, warfarin, lidocain, phenytoin [cimetidine has most risk]; inhibit absorption of drugs that requre ac
H2 Receptor Antagonists
interventions
for optimal results H2RAs should be taken 1-2 hours before antacids; caution with elderly b/c more likely to have adverse effects of disorientation/confusion; risk for hypotension with IV administration; monitor for GI bleeding in patients with ulcers or
Proton Pump Inhibitors
drugs
omprazole (Prilosec), lansoprazole (Prevacid), pantoprazole (Protonix), esomeprazole (Nexium)
Proton Pump Inhibitors
actions
irreversibly binds to proton pump thus blocking all gastric acid secretion; to return secretion PPI will be stopped and parietal cells must synthesize new hydrogen-potassium-ATPase (proton pump); does not affect absorption of food
Proton Pump Inhibitors
indications
erosive esophagitis, symptomatic GERD, short-term treatment of active duodenal ulcers and active benign gastric ulcers, gastric hypersecretory conditions, NSAID induced ulcers, stress ulcer prophylaxis, in comboination with antibotics to treat h. pylori i
Proton Pump Inhibitors
contraindications
allergy
Proton Pump Inhibitors
side effects
risk of GI tract infection b/c of reduction of normal acid-mediated antimicrobial protection; increase risk of osteoporosis
Proton Pump Inhibitors
interactions
increase serum levels of diazepam and phenytoin; risk of bleeding when taken with warfarin; interferes w/ absorption of ketoconazole, ampicillin, iron salts, digoxin; when given w/ clopidogrel- increased risk of death in patients' w/ ACS; sucralfate may d
Proton Pump Inhibitors
interventions
take on an empty stomach; oral forms work best when taken 30-60 minutes before meals; monitor for abd pain, distention, abnormal bowel sounds
LANSOPRAZOLE: oral dose taken with fluids; can be opened and mixed (not crushed) with applesauce; solu-tab can be
Miscellaneous Acid-Controlling Drugs
drug
sucralfate (Carafate)
Miscellaneous Acid-Controlling Drugs
sucralfate (Carafate) Action
acts locally by binding directly to surface of an ulcer creating a protective barrier like a "liquid bandage
Miscellaneous Acid-Controlling Drugs
sucralfate (Carafate)
indications
active stress ulceration, esophageal erosions, long term therapy for PUD
Miscellaneous Acid-Controlling Drugs
sucralfate (Carafate)
contraindications
allergy
Miscellaneous Acid-Controlling Drugs
sucralfate (Carafate)
side effects
nausea, constipation, dry mouth
Miscellaneous Acid-Controlling Drugs
sucralfate (Carafate)
interactions
interfers w/ absorption of other drugs
Miscellaneous Acid-Controlling Drugs
sucralfate (Carafate)
interventions
take other durgs at least 2 hours before to prevent alterations in absorption; give on an empty stomach; best given 1 hour before meals and at bedtime; can be crushed or dissolved in water; avoid antacids 30 minutes before or after administration; sugarle
Miscellaneous Acid-Controlling Drugs
misoprostol (Cytotec)
misoprostol (Cytotec)
Miscellaneous Acid-Controlling Drugs
misoprostol (Cytotec)
actions
a prostaglandin E analogue, inhibits gastric acid secretion, protect gastric mucosa from injury
Miscellaneous Acid-Controlling Drugs
misoprostol (Cytotec)
indications
reduce incidence of gastric ulcers in patients taking NSAIDs
Miscellaneous Acid-Controlling Drugs
misoprostol (Cytotec)
contraindications
drug allergy; pregnancy (category X)
Miscellaneous Acid-Controlling Drugs
misoprostol (Cytotec)
side effects
head ache, GI distress, vaginal bleeding
Miscellaneous Acid-Controlling Drugs
misoprostol (Cytotec)
interactions
antacids may reduce absorption
Miscellaneous Acid-Controlling Drugs
misoprostol (Cytotec)
interventions
should be given with food and at bed time
Miscellaneous Acid-Controlling Drugs
simethicone (Mylicon)
action
alters elasticity of mucus-coated gas bubbles, making them break into smaller ones
Miscellaneous Acid-Controlling Drugs
simethicone (Mylicon)
indications
reduce gas pain and facilitate gas expulsion through mouth or rectum
Miscellaneous Acid-Controlling Drugs
simethicone (Mylicon)
interventions
take after meals and at bed time; tablets should be chewed thoroughly; suspensions should be shaken well before use; encourage patients to avoid gas producing foods and carbonated beverages
Antidiarrheals
drugs
adsorbents: bismuth subsalicylate (Pepto-Bismol)
� anticholinergics: belladonna alkaloid (Donnatal)
� opiate: diphenoxylate (Lomotil, Lonox), loperamide (Imodium A-D)
� intestinal flora modifiers: lactobacillus acidophilus (Bacid)
Antidiarrheals
actions
adsorbents: coat walls of GI tract, bind to bacteria/toxin to their surface for elimination from the body through stool � anticholinergics: slow peristalsis by redcing rhythmic contractions and smooth muscle tone of GI tract
� intestinal flora modifiers:
Antidiarrheals
Indications
diarrhea-> adsorbents for mild cases, anticholinergics and opioids for severe cases, intestinal flora modifiers for antibiotic-induced diarrhea
Antidiarrheals
Contraindications
drug allery, major acute GI condition like intestinal obstruction or colitis
belladonna alkaloid: narrow-angle glaucoma, GI obstruction, myasthenia gravis, paralytic ileus, toxic megacolon
diphenoxylate: pseudomembranous colitis, toxigenic bacteria
lopera
Antidiarrheals
Side Effects
bismuth subsalicylate: increased bleeding time, constipation, dark stools, confusion, tinnitus, metallic taste, blue gums
� atropine/hyoscyamin: urinary retention and hesitancy, impotence, headache, dizziness, anxiety, drowsiness, confusion, bradycardia,
Antidiarrheals
interactions
adsorbents: decrease effects of digoxin, clindaycin, quinidine, probenecid, hypoglycemic drugs; increase bleeding time and brusing with warfarin (especially bismuth subsalicylate); increased risk for toxicity with methotrexate
� anticholinergics: decrease
Antidiarrheals
interventions
encourage awareness of fluid intake and dietary changes that may impact or exacerbate present symptoms; document bowel pattern changes, wieght, fluid volume status, I&O, mucous membranes before, during, and after start of treatment
� BISMUTH SUBSALICYLATE
Laxatives
Bulk-Forming
Drugs
bulk-forming: methylcellulose (Citrucel), psyllium (Metamucil)
Laxatives
Bulk-Forming
Actions
act in a similar manner to fiber in diet; absorb water into intestine, which increases bulk and distends bowel to initiate reflex bowel activity, promoting bowel movement
Laxatives
Bulk-Forming
Indications
acute and chronic constipation, IBS, diverticulosis
Laxatives
Bulk-Forming
contraindications
drug allergy; cautious use in presence of acute surgical abdomen, appendicitis symptoms, fecal impaction (exept for mineral oil enemas), intestinal obstruction, undiagnosed abdominal pain
Laxatives
Bulk-Forming
side effects
impaction above structures, fluid disturbances, electrolyte imbalances, gas formation, esophageal blockage, allergic reaction
Laxatives
Bulk-Forming
interactions
decrease absorption of antibiotics, digoxin, nitrofurantion, salicylates, tetracyclines, warfarin
Laxatives
Bulk-Forming
interventions
take with water to prevent esophageal obstruction and/or fecal impaction; take with at least 8oz of fluid, thoroughly stir, and take immediately to avoid chocking or swelling of product in throat or esophagus; should not be taken in its dry form; only lax
Laxatives
emollient:
drugs
docusate salts (Colace) [stool softener], mineral oil (Kondremul Plain) [lubricant laxative]
Laxatives
emollient:
action
fecal softener: lowers suface tension of GI fluids so that more water and fat are absorbed int stool and intestines
lubricant: lubricates fecl material and intestinal wall and prevents absorption of water from intestines
Laxatives
emollient:
indications
acute and chronic constipation, fecal impaction, anorectal conditions requiring facilitation of bowel movements
Laxatives
emollient
contraindi
drug allergy; cautious use in presence of acute surgical abdomen, appendicitis symptoms, fecal impaction (exept for mineral oil enemas), intestinal obstruction, undiagnosed abdominal pain