1Which patient does the nurse identify as being at highest risk for the development of an adverse drug reaction?
A. A 1-month-old patient whose mother has allergies to penicillin, aspirin, and codeine
B. A 16-year-old patient with multiple traumatic injuries who is taking morphine and an antibiotic
C. A 54-year-old patient with multiple sclerosis who has been enrolled in a clinical trial of a new drug
D. An 84-year-old patient with diabetes, heart failure, and hypertension who takes seven prescription medications each
day
D kidney and liver function decrease.
2Question 2
A patient is prescribed a medication that is potentially hepatotoxic. Before administering the medication, it is most important for the nurse to assess what?
A. Blood urea nitrogen and serum creatinine
B. Aspartate aminotransferase and alanine
aminotransferase
C. Prolonged QT interval on the electrocardiogram
D. Serum potassium, serum sodium, and serum
magnesium
B. Hepatotoxic means that it can be damaging to the liver. The nurse should assess the liver function tests of patients who are taking hepatotoxic drugs. When liver cells are injured, two liver enzymes (aspartate aminotransferase [AST] and alanine aminotransferase [ALT]) will be elevated.
3Which individual is at the highest risk for a drug-drug interaction?
A. A toddler who is prescribed two antibiotics for a serious infection
B. An adolescent who takes over-the-counter medications for menstrual cramping
C. An adult who takes eight prescription medications for a chronic condition
D. An older adult who takes two prescription medications and a dietary supplement for anxiety
C
4The nurse cares for a patient who is taking a calcium channel blocker for hypertension. The nurse should be most concerned if the patient makes which statement?
A. “I take my medication with a glass of water.”
B. “I eat foods high in fiber to prevent constipation.”
C. “I drink a glass of grapefruit juice each evening.”
D. “I avoid foods such as broccoli and cabbage.”
C
5A patient is prescribed a medication to be taken on an empty stomach. Which statement should the nurse include when providing patient teaching?
A. “Take the medication 1 hour before eating.”
B. “Take the medication with a small glass of water.”
C. “Take the medication before going to bed at night.”
D. “Take the medication 1 hour after a meal.”
A
6Which information should the nurse include when teaching a patient about isoniazid (INH) therapy?
A. Tubercle bacilli cannot develop resistance to isoniazid during treatment.
B. Isoniazid is administered intravenously.
C. An adverse effect of isoniazid therapy is peripheral neuropathy, which can be reversed with pyridoxine.
D. The dose of isoniazid should be lowered if the patient is also taking phenytoin.
C
7Which information should the nurse include when teaching a patient about rifampin therapy?
A. Oral contraceptives are safe to use with rifampin therapy.
B. Contact your healthcare provider immediately if the color of your body fluids changes to reddish orange.
C. Rifampin is safe to use in patients who have hepatic disease.
D. Rifampin may be administered intravenously.
D
8A nurse is planning discharge teaching for a female client who has a new prescription for Trimethoprim-sulfamethoxazole. Which of the following information should the nurse include?
• A. Take the medication even if pregnant
• B. Maintain a fluid restriction while taking it
• C. Take in on an empty stomach
• D. Stop taking it when manifestations subside
take it on an empty stomach
9Question
• Which statement about erythromycin is correct?
A It inhibits cell wall formation of organisms
B It used to treat infections in clients who are allergic to penicillin
C liver function should be monitored when clients are on the drugs
D teach clients to take it with meals usually
E Monitor ECG for this drug
B,C,D,E
10A nurse is preparing to administer cefotaxime (claforan) IV to a client who has a severe infection and has been receiving cefotaxime for the past week. Which of the following findings indicates a potentially serious adverse reaction to this medication and should be reported to the provider?
A diaphoresis B diarrhea
C alopecia
D epistaxis
D
11
Flashcard 1
Front: What is an allergic drug reaction?
Back: An immune response to a drug, often causing rash, hives, or anaphylaxis.
12
Flashcard 2
Front: What is a paradoxical drug reaction?
Back: A reaction where the drug causes an effect opposite to what is expected.
13
Flashcard 3
Front: How do you monitor liver toxicity in patients on medication?
Back: Through liver function tests, observing for symptoms like jaundice, and checking enzyme levels like ALT and AST.
14
Flashcard 4
Front: How is kidney toxicity monitored?
Back: By measuring serum creatinine, blood urea nitrogen (BUN), and monitoring urine output.
15
Flashcard 5
Front: What is an example of a drug-to-drug interaction that increases therapeutic effects?
Back: Using aspirin with clopidogrel to enhance antiplatelet effect.
16
Flashcard 6
Front: Name a food high in Vitamin K that affects Warfarin therapy.
Back: Green leafy vegetables like spinach and kale.
17
Flashcard 7
Front: What is the purpose of a culture and sensitivity test in antibiotic therapy?
Back: To identify the causative bacteria and determine which antibiotics are effective against it.
18
Flashcard 8
Front: What is a superinfection?
Back: A secondary infection that occurs during or after treatment of a primary infection, often due to antibiotic use.
19
Flashcard 9
Front: What is the function of a beta-lactamase inhibitor?
Back: To prevent bacterial enzymes from breaking down beta-lactam antibiotics, thereby enhancing their effectiveness.
20
Flashcard 10
Front: What is a major adverse reaction (ADR) of penicillin?
Back: Allergic reactions, ranging from rash to anaphylaxis.
21
Flashcard 11
Front: What is a major contraindication for Tetracycline?
Back: It should not be used in children under 8 years or during pregnancy due to risks to bone growth and teeth development.
22
Flashcard 12
Front: What is a common first-line treatment for uncomplicated UTIs?
Back: Trimethoprim/sulfamethoxazole (Bactrim).
23
Flashcard 13
Front: What are key signs of aminoglycoside toxicity?
Back: Nephrotoxicity (kidney damage) and ototoxicity (hearing damage).
24
Flashcard 14
Front: Which antibiotic is commonly associated with causing C-diff infections?
Back: Clindamycin.
25
Flashcard 15
Front: What is a significant adverse reaction of macrolides like Erythromycin?
Back: Gastrointestinal disturbances, including nausea and diarrhea.
26
Flashcard 16
Front: What is a critical drug-to-food interaction to consider with Metronidazole?
Back: Avoid alcohol due to the risk of a disulfiram-like reaction.
27
Flashcard 17
Front: What is a major side effect of Rifampin, a drug used in TB treatment?
Back: Hepatotoxicity and orange-red discoloration of body fluids.
28
Flashcard 18
Front: What is a common adverse reaction to Amphotericin B?
Back: Infusion reactions and nephrotoxicity.
29
Flashcard 19
Front: What is the primary action of antiviral drugs like acyclovir?
Back: They inhibit viral DNA replication.
30What are the types of adverse drug reactions and how do you monitor liver and kidney toxicity?
Allergic: Immune response causing hypersensitivity. Paradoxical: Opposite of the expected effect. Idiosyncratic: Unpredictable and rare reaction. Monitor liver toxicity: Liver function tests (AST, ALT). Monitor kidney toxicity: Creatinine clearance, serum creatinine, BUN.
31
Describe drug-to-drug and drug-to-food interactions, specifically with Warfarin/Vitamin K and MAOIs/tyramine.
Increased therapeutic effects: Potentiation or synergism. Increased adverse effects: Heightened side effects or toxicity. Reduced therapeutic effects: Diminished efficacy due to antagonism. Reduced adverse effects: Side effects minimized by another drug. Warfarin and Vitamin K: Vitamin K decreases Warfarin's effectiveness. MAOIs and tyramine: Tyramine increases the risk of hypertensive crises with MAOIs.
32
Antibiotics Overview Front: What general information should be known about antibiotics?
Types of antibiotics: Bactericidal vs. bacteriostatic. Culture and sensitivity: Guides effective antibiotic choice. Superinfection: Secondary infection from normal flora destruction. Drug resistance: When bacteria no longer respond to antibiotics. Use guideline: Base on culture, sensitivity; avoid broad-spectrum when possible. Indications: Treatment of bacterial infections.
33
What are key points regarding beta-lactam antibiotics?
Beta-lactamase inhibitor: Protects penicillin from bacterial enzymes. Cross-allergy reactions: Possible among all beta-lactam antibiotics. Cephalosporins: Varied spectrum and efficacy with each generation. MOA: Inhibit bacterial cell wall synthesis. Major ADRs for penicillin, cephalosporin, Vancomycin: Allergic reactions, GI upset, nephrotoxicity, ototoxicity. Nursing interventions: Allergy monitoring, renal function tests.
34
What should be noted about tetracycline use?
Indication: Chronic bronchitis, acne, chlamydia. Contraindication: Pregnancy, children under 8. Major ADR: Tooth discoloration, photosensitivity. Client education: Avoid dairy, iron, antacids; sun protection. Food-drug interaction: Calcium and iron bind tetracycline. Nursing interventions: Administer on an empty stomach, educate on sun exposure.
35
What is important about UTI treatment?
Treatment: Based on urine culture and sensitivity. Antibiotics: Often start with a broad-spectrum like trimethoprim/sulfamethoxazole. Client education: Increase fluid intake, complete antibiotic course. Nursing interventions: Monitor for effectiveness and adverse reactions.
36
How do you handle aminoglycoside toxicity?
Toxicity signs: Ototoxicity, nephrotoxicity. Interventions: Monitor serum drug levels, renal function tests, hearing tests.
37
What are the major ADRs and nursing considerations for sulfonamides?
Major ADRs: Stevens-Johnson syndrome, hematologic effects. Contraindications: Sulfa allergy, G6PD deficiency. Nursing considerations: Monitor for skin reactions, encourage fluids, watch for signs of anemia.
38
What should patients know about fluoroquinolones like Ciprofloxacin?
Major ADR: Tendonitis, tendon rupture. Food-drug interaction: Avoid calcium-rich foods which can interfere with absorption. Client education: Report tendon pain, avoid sun exposure.
39
What antibiotics commonly cause C. diff, and what are the treatment choices?
Antibiotics: Clindamycin, cephalosporins, fluoroquinolones. Symptoms: Diarrhea, abdominal pain. Treatment: Metronidazole, Vancomycin.
Compare Erythromycin and Azithromycin, and their ADRs.
40
Outline the treatment, ADRs, and prevention for TB.
Treatment course: 6-9 months with a combination of drugs. ADRs of major drugs: Hepatotoxicity, peripheral neuropathy. Latent vs Active TB: Latent is non-infectious and asymptomatic; active is infectious and symptomatic. Drug resistance prevention: Directly observed therapy (DOT). Drug adherence: Essential to prevent resistance and ensure cure.
41
What are the considerations for antifungal medications like Amphotericin B and Azoles?
Amphotericin B: Used for severe systemic infections. Infusion reaction: Fever, chills, hypotension. Azole drugs: Used for less severe infections. Major ADR: Liver toxicity, GI upset. Nursing interventions: Pre-medicate for infusion reactions, monitor liver enzymes.
42
Discuss the MOA and major ADRs of antiviral drugs such as Acyclovir, Zidovudine, and Ritonavir.
MOA of antiviral drugs: Inhibit viral DNA replication. Acyclovir: Used for herpes simplex and varicella-zoster virus. Major ADR of Acyclovir: Nausea, headache, renal toxicity. Zidovudine and Ritonavir: Used for HIV. MOA of Zidovudine and Ritonavir: Inhibit viral reverse transcriptase and protease, respectively. Major ADR: Bone marrow suppression (Zidovudine), GI upset (Ritonavir). Nursing interventions: Monitor blood counts, liver enzymes, educate on adherence.