NURS 6521 Advanced Pharmacology – Week 5 – Quiz

MAOIs such as phenelzine carry a significant risk of injury that results from the multiple interactions associated with these drugs. Infection, impaired tissue perfusion, and constipation are less common, and less serious, adverse effects. NURS 6521 Advanced Pharmacology – Week 5 – Quiz

When diazepam is administered intravenously during status epilepticus, the small veins in the dorsum of the hand or the wrist should be avoided. It should be injected slowly, no faster than 5 mg in 1 minute. Diazepam should not be mixed or diluted with other solutions or drugs, either in the syringe or in intravenous solutions.

The use of olanzapine creates a significant risk of hyperglycemia. This is of particular concern in patients and clients who have diabetes mellitus. Smoking affects the pharmacodynamics of olanzapine, but this is less likely to result in serious adverse effects. Obesity, low BMI, and recent antibiotic use are not associated with a significantly increased risk of adverse effects. NURS 6521 Advanced Pharmacology – Week 5 – Quiz

Acetylcholine and cevimeline are both cholinergic agonists, and, like carbachol, would be contraindicated in this patient. Administration of either of these drugs could be fatal. Nicotine is a direct-acting nicotinic agonist and is not indicated in cholinergic poisoning. Atropine is considered the antidote for cholinergic poisoning. The actions of atropine are a reduction in salivary, bronchial, and sweat gland secretions; mydriasis; cycloplegia; changes in heart rate; contraction of the bladder detrusor muscle and of the gastrointestinal smooth muscle; decreased gastric secretion; and decreased gastrointestinal motility.

Morphine, like most opioid analgesics, creates a risk for constipation. The drug is unlikely to influence the patient’s temperature, skin integrity, or urine specific gravity. NURS 6521 Advanced Pharmacology – Week 5 – Quiz

Zolpidem generally is not used for more than 7 to 10 days at a time. It induces sleep rapidly and should be taken immediately before going to bed. It is true that the drug does not seem to produce residual effects the next morning or cause prolonged rebound effects when it is discontinued. It is available in both quick-onset and continuous-release oral forms, and common adverse effects of the drug are headache, prolonged drowsiness, and dizziness.

The nurse must assess the patient’s pain intensity before and after administering an opioid analgesic. The respiratory rate and level of consciousness need to be assessed because respiratory depression and sedation are two adverse effects of opioid analgesics. Seizure activity, electrolytes, liver function, blood glucose level, and mental status may need to be assessed during opioid analgesic therapy related to adverse effects, but they would not be the priority assessments.

CNS stimulants like cocaine initially increase heart rate and blood pressure. Cocaine impairs the uptake of norepinephrine and epinephrine by presynaptic nerve endings, thus activating the adrenergic systems and causing hypertension, tachycardia, and vasoconstriction.

The nurse will assess for cimetidine use. Cimetidine greatly increases the level of circulating zaleplon and could cause toxic effects in the patient. Secobarbital is a barbiturate, and oxycodone and meperidine are narcotics that would not be used with lorazepam because the combinations may depress respiratory drive, create severe hypotension or bradycardia, and substantially alter level of consciousness. NURS 6521 Advanced Pharmacology – Week 5 – Quiz

Propofol is relatively contraindicated in patients with a history of seizure disorders because they are at risk of developing convulsions during the recovery phase. This drug should be used with caution in patients with low blood pressure because it can aggravate this condition. Also, it should be used with caution in patients with increased intraocular pressure because it can cause a substantial reduction in cerebral perfusion. Because disorders of lipid metabolism can be aggravated by the emulsion vehicle in which propofol is delivered, it should be used with caution in patients with diabetic hyperlipidemia.

Nicotine in any dosage form should not be used in patients immediately after myocardial infarction, or in those with life-threatening arrhythmias or severe or worsening angina pectoris. Antibiotics, anticoagulants, and renal failure are not contraindications for the use of nicotine as an aid to smoking cessation.

Like all benzodiazepines, lorazepam increases the effects of GABA, which has an inhibitory effect on the CNS. However, none of the benzodiazepines act like GABA or increase the amount of GABA present. MAOIs inhibit monoamine oxidase and tricyclic antidepressants primarily affect serotonin and norepinephrine levels. SSRIs increase the availability of serotonin in the synapses. NURS 6521 Advanced Pharmacology – Week 5 – Quiz

The use of long-acting analgesia combined with short-acting opioids for breakthrough pain is a proactive pain management technique that maximizes therapeutic benefit while minimizing the risks of adverse effects.

The duration of the morphine may be longer than the duration of naloxone. Therefore, naloxone has a shorter half-life than morphine. Repeated doses may be necessary to maintain reversal of the opiate’s effects. Naloxone does not increase the action of morphine, and it causes the respiratory rate to increase, not decrease. Dosage strength is not associated with drug duration.

Long-term phenytoin therapy is associated with folate deficiency. Folic acid and phenytoin are structurally similar and thought to compete with each other for the same receptors. A deficiency in folic acid in a pregnant woman can cause birth defects. Potassium, iron, and vitamin C do not compete with phenytoin nor are they directly affected by phenytoin.

The nurse will most likely administer the zaleplon to the 35-year-old man who is having difficulty falling asleep, but once asleep can stay asleep. Zolpidem would most likely be administered to the 20-year-old who will take a sleep aid only once a week. Eszopiclone (Lunesta) will be given to the 52-year-old woman who needs to fall asleep quickly and has trouble staying asleep. The 46-year-old man will likely receive trazodone (Desyrel). This drug is given as a sleep aid for a patient who is taking an antidepressant.

The patient who has history of alcohol or substance abuse may be a poor candidate for lorazepam because the patient is more likely to develop dependence on the drug. Alcohol will also have an additive effect with lorazepam. A diet high in fat and carbohydrates or nicotine use should not affect the use of lorazepam.

The nurse will inform the patient that it will likely take 3 to 4 weeks of treatment before she notices consistent relief of her anxiety. However, some improvement is often seen within 7 to 10 days of starting therapy. Since the patient had only been taking the drug 1 week, there is no need to inform the physician. The nurse would not make the assumption that the medication is not going to work for the patient nor would she tell her that it would take up to 6 months to see therapeutic results.

Abrupt withdrawal from long-term use of sedative–hypnotic drugs should never be attempted because withdrawal symptoms are serious and potentially fatal. Withdrawal symptoms include agitation, dysphoria, insomnia, vomiting, diarrhea, ataxia, hallucinations, acute psychosis, muscle and abdominal cramps, anorexia, and seizures. These symptoms may occur 12 to 72 hours after the last use of the drug and may last up to 14 days. The abrupt withdrawal of benzodiazepines, opioids, and amphetamines does not cause such severe and potentially fatal withdrawal symptoms. NURS 6521 Advanced Pharmacology – Week 5 – Quiz

The therapeutic range for lithium is 0.6 to 1.2 mEq/L. A level of 0.3 mEq/L would not be in the therapeutic range and would therefore not produce a therapeutic response. Levels of 0.6 and 1.2 mEq/L would be within the therapeutic range and would not be expected to produce adverse effects. A level of 1.7 mEq/L would be a high level and place the patient at risk for adverse effects or overdose.

Atropine is used to help restore normal sinus rhythm in emergency situations, such as symptomatic bradycardia, pulseless electrical activity, ventricular asystole, or cardiopulmonary resuscitation. It does not resolve acid-based imbalances or decreased level of consciousness and atropine increases, rather than decreases, blood pressure.

Neuroleptic malignant syndrome is characterized by fever, sweating, tachycardia, muscle rigidity, tremor, incontinence, stupor, leukocytosis, elevated creatinine phosphokinase levels, and renal failure. Agitation, pruritis, thirst, and increased urine output are not indicative of neuroleptic malignant syndrome.

The negative symptoms of schizophrenia include flat or blunted emotions, lack of pleasure or interest in things (anhedonia), and limited speech. The positive symptoms of schizophrenia, and the most recognizable symptoms, include delusions (e.g., paranoia or distorted perceptions of other people’s intentions) and hallucinations.

The nurse should instruct the wife to continue offering her husband the drug and that it will probably take several days to reach its full therapeutic effect. The dosage would not be increased, decreased, or discontinued.

The nurse will instruct the patient that it will take approximately 24 hours for the full pain-relieving effect of a fentanyl transdermal patch to occur. NURS 6521 Advanced Pharmacology – Week 5 – Quiz

Muscle twitching is an early symptom of lithium toxicity and should be reported immediately. Muscle twitching indicates that a dosage change may be needed. Increased thirst and urination are acute effects of lithium, whereas hair loss is a chronic adverse effect.

A patient taking acetaminophen should be taught the common adverse effects of the drug, which include rash, urticaria, and nausea. Nausea, not gastrointestinal distress, is a common adverse effect of acetaminophen. Flushing, dizziness, and feelings of tingling, heat, and fatigue are the most common adverse effects of sumatriptan, not acetaminophen.

Addiction to opioids is a rare occurrence among hospital patients who do not have a history of drug abuse. It would be inappropriate to downplay the patient’s concerns, however. A more appropriate response would be to explain the phenomenon of dependence and to differentiate it from addiction. NURS 6521 Advanced Pharmacology – Week 5 – Quiz

Buspirone does not cause as much sedation and functional impairment as lorazepam, alprazolam, and diazepam. However, it can cause dizziness, nausea, headache, nervousness, lightheadedness, or excitement.

The nurse will closely monitor for the adverse effects of phenelzine related to the anticholinergic effect of the drug, such as dizziness that tends to be more pronounced at dosages above 45 mg/day. Dizziness is also a sign of a phenelzine drug overdose. Constipation and dry mouth are also adverse effects, not diarrhea and increased secretions. Facial flushing is not an identified adverse effect of phenelzine.