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Pharmacology
Every Week Quiz Concepts
| Question | Answer |
|---|---|
| Sucralfate is a pepsin inhibitor that does not absorb in the body | but instead forms a protective cover to adhere to the ulcer’s surface. |
| Sucralfate is used in the treatment of | PUD. |
| Misoprostol is a synthetic prostaglandin equivalent that suppresses gastric acids and | increases the secretion of the protective gastric membrane. |
| Misoprostol is used in the | prevention and treatment of NSAID-induced peptic ulcers. |
| Metoclopramide is a prokinetic drug that promotes gastric motility and can be used for | gastroparesis, gastroesophageal reflux, and nausea and vomiting. |
| Sucralfate’s onset of action is _____________ This is when the patient might expect to experience some relief. | 1 to 2 hours. |
| Misoprostol is 80% to 90% protein bound. | This statement is accurate. Most misoprostol can be found bound to proteins (80% to 90%). |
| IV metoclopramide is approved to treat | nausea and vomiting. |
| ____ may be managed with oral metoclopramide. | GERD |
| Assess the patient taking sucralfate, misoprostol, or metoclopramide for GI symptoms such as | abdominal pain or blood in stools. |
| For patients taking metoclopramide, assess frequently for signs of _________________ such as facial grimacing, sticking the tongue out, and mouth movements | tardive dyskinesia (involuntary movement) |
| Because misoprostol is an abortifacient and contraindicated for pregnant women, it is essential for the nurse to assess patients taking this drug for | possible pregnancy. Misoprostol can cause abortions; |
| Advise the patient to avoid foods and liquids that cause gastric irritation (caffeine, alcohol) when taking | antiulcer drug |
| Instruct the patient taking antiulcer drug to eat small, frequent meals that are | low in fat. |
| _______________ is contraindicated while on Misoprostol | Breastfeeding |
| Incidence of diarrhea may be lessened by taking misoprostol | immediately after meals. |
| Inform the patient that possible side effects of taking misoprostol include | abdominal pain, diarrhea, nausea, flatulence, dyspepsia, headache, vomiting, and constipation. |
| Before the administration of _____________, ________________ and ________________, a nurse should thoroughly assess the patient for any signs, symptoms, or other medications that would contraindicate safe use of the medication. | sucralfate, misoprostol, or metoclopramide |
| Neither sucralfate nor misoprostol will alleviate gastric pain; however, they can interfere in the absorption of other medications, such as | antacids. |
| Sucralfate is best administered on an empty stomach for maximum efficacy. It should be taken before meals and at bedtime. | The antacid should be taken either 30 minutes before or 30 minutes after the administration of sucralfate. |
| Contraindications: Hypersensitivity to ___________ ; GI obstruction, perforation, or hemorrhage; pheochromocytoma; seizure disorder; history of tardive dyskinesia. | metoclopramide |
| Cautions: Chronic kidney disease (caused by accumulation of aluminum), hypersensitivity. | Sucralfate |
| Contraindications: Allergy to prostaglandins, pregnancy (when used to reduce NSAID-induced ulcers; also produces uterine contractions) | Misoprostol |
| Drug Interactions: May decrease absorption of digoxin, ketoconazole, levothyroxine, phenytoin, quinidine, quinolones (e.g., ciprofloxacin), ranitidine, tetracycline, theophylline. | Sucralfate |
| Cautions: Renal impairment, cardiovascular disease, older adult patients | Misoprostol |
| When taking antacids with misoprostol, the concentration of misoprostol may | increase |
| Misoprostol is a ___________________________ that works by suppressing gastric acids and increasing the secretions that make the protective gastric mucosal barrier in the GI tract | synthetic prostaglandin analog |
| Metoclopramide is a prokinetic drug used to increase ___________ in the GI tract. | motility |
| Sucralfate is a __________________ that works by binding with another protein and forming a protective layer over the ulcer to prevent further erosion from gastric acids. | pepsin inhibitor |
| Which patient parameter would a nurse ensure has been determined in a 25-year-old female patient receiving misoprostol for prevention of nonsteroidal antiinflammatory drug (NSAID)–induced ulcers? | Pregnancy test findings should be documented before a patient who is of childbearing age receives misoprostol. Additionally, the drug should be initiated 2 to 3 days after the next menstrual period to ensure the patient is not pregnant. |
| Which patients can safely receive misoprostol? | A patient with epilepsy, alcoholism, Parkinson's disease and pheochromocytoma |
| Which patient has an indication to safely receive misoprostol? | A patient with rheumatoid arthritis who is taking NSAIDs A patient with rheumatoid arthritis who is receiving NSAIDs may receive misoprostol to prevent the risk for NSAID-induced gastric ulcers. |
| Which time frame would a patient expect the effects of oral metoclopramide to last? | 3 to 4 hours Oral metoclopramide has a duration of action of 3 to 4 hours. |
| Which statement is accurate regarding the pharmacokinetics of sucralfate? | The drug is excreted in the urine. This statement is accurate because sucralfate is excreted in the urine. |
| Which time frame describes misoprostol’s elimination half-life? | 20 to 40 minutes A time frame of 20 to 40 minutes is the elimination half-life of misoprostol. |
| Which patient parameters would a nurse ensure are documented before administration of sucralfate? | Before giving sucralfate, check URINE OUTPUT to check renal function & report urine output <600 mL/day or <30 mL/hour. Level of GI pain before giving sucralfate, including the type, duration, severity, and frequency. |
| A nurse is caring for patient who is taking levothyroxine and has been prescribed sucralfate. Which outcome would the nurse anticipate will occur from this drug interaction? | Increased dosage of levothyroxine When taking sucralfate with levothyroxine, the absorption of levothyroxine may be reduced. As a result, a dosage increase of levothyroxine may be warranted. |
| Which patient parameters would a nurse ensure are monitored in a patient receiving metoclopramide? | Check heart rate, temp (hyperthermia) & BP to monitor for neuroleptic malignant syndrome (NMS) - Unusual facial or tongue movements to monitor for tardive dyskinesia. (All are adverse effects) |
| Which statement made by a lactating female patient regarding misoprostol therapy requires further intervention? | “I should take magnesium-containing antacids to help with any stomach issues from misoprostol.” Patients should avoid magnesium-containing antacids because they can worsen diarrhea when receiving misoprostol. |
| Which teaching points would be shared by a nurse with a patient who is receiving metoclopramide as orally disintegrating tablets? | Continue taking even if feeling better. Avoid alcohol due to sedation. Because of sedation, avoid driving or other hazardous activities until stabilized on the medication. Oral disintegrating tablets; placed under tongue to dissolve & swollow. |
| (PPIs) | Proton pump inhibitors |
| Proton pump inhibitors are | gastric acid suppressors indicated for the relief of abdominal symptoms associated with gastroesophageal reflux disease (GERD) and uncomplicated peptic ulcers and have been found to be highly effective and generally well tolerated. |
| Adverse drug reactions to PPIs, | pneumonia (especially older adults), fractures, rebound hypersecretion of hydrochloric acid, and susceptibility to infection |
| Although histamine agonists (H2 blockers) also suppress gastric secretions, PPIs block ____ more. | 90% |
| The first PPI introduced to the market was __________ | omeprazole |
| _____________ has a higher success rate for healing erosive GERD than omeprazole. | Esomeprazole |
| All PPIs, if prescribed in large doses, can also be combined with _______________ to treat Helicobacter pylori (H. pylori). | antibiotics |
| Omeprazole and esomeprazole are primarily metabolized in the ________. | liver |
| Omeprazole (PPI) Pharmacodynamic Profile | Onset: Within 1 hr Duration: Up to 72 hr Peak: 2 hr Half-life: 0.5-1 hr (increased in hepatic impairment) |
| Esomeprazole (PPI) Pharmacodynamic Profile | Onset: Within 1 hr Duration: Up to 72 hr Peak: 1.5-2 hr Half-life: 1-1.5 hr |
| Like omeprazole, esomeprazole is activated by the parietal cells of the stomach and ________________. Higher blood levels are achieved with esomeprazole; therefore its effects last longer. | inhibits the enzyme that generates gastric acid |
| Omeprazole is activated by the parietal cells of the stomach causing an inhibition of the enzyme (H+, K+ -ATPase) that generates gastric acid. Omeprazole promotes ___________________ until new enzyme is synthesized, thus making it longer acting. | irreversible hydrogen or potassium ATPase inhibition |
| Esomeprazole is metabolized more __________ than omeprazole and hence achieves a higher blood level, resulting in longer-lasting effects. | slowly |
| Absorption: Rapidly absorbed from the gastrointestinal (GI) tract Distribution: Primarily distributed in gastric parietal cells Protein binding: 95% Metabolism: Metabolized in liver Excretion: Primarily excreted in urine | Omeprazole |
| Absorption: Well absorbed after oral (PO) administration Distribution: Protein binding: 97% Metabolism: Extensively metabolized in liver Excretion: Primarily excreted in urine | Esomeprazole |
| Omeprazole and esomeprazole are primarily metabolized in the liver. Esomeprazole is metabolized more slowly than omeprazole and, hence, achieves a higher blood level resulting in____________________effects. | longer-lasting |
| PPIs can interfere with certain _________ drugs (such as protease inhibitors, tipranavir, and atazanavir) and some antifungal drugs. | HIV/AIDS |
| PPIs may increase the risk for development of __________. Assess patients for risk or history of this disorder. | osteoporosis |
| Some PPI formulations of PO capsules are relatively large. Determine the patient’s ability to _________ them before administering. | swallow |
| Esomeprazole may increase risk for hip, wrist, or spine fractures, hepatic impairment in older adults and _____________ (due to increased risk for dementia). Concurrent use of CYP3A4 inducers and use in breastfeeding mothers are not recommended. | Asian populations |
| Omeprazole may increase risk for fractures and GI infections. May increase risk for hepatic impairment in patients of Asian descent (due to increased risk for dementia). Not recommended for use in ___________ mothers. | breastfeeding |
| Contraindications for Esomeprazole include: | Hypersensitivity to benzimidazoles, concomitant use of other PPIs |
| Contraindications for Omeprazole include: | Hypersensitivity to other PPIs |
| Clopidogrel—Some evidence indicates that there is a _________ in activation of clopidogrel when taken with a PPI. However, information is inconclusive. | decrease |
| Teach patients taking _____________ to collaborate with their health care provider to determine the right course of action regarding whether a PPI is right for them. | clopidogrel |
| HIV protease inhibitors—PPIs are contraindicated for patients taking __________. For patients taking atazanavir, omeprazole dosage should not exceed 20 mg/day. | rilpivirine |
| Methotrexate—When taken with high doses of PPIs, methotrexate elimination is slowed; therefore the patient may experience ______________ toxicity. | methotrexate |
| Diazepam Phenytoin Digoxin Carbamazepine | Medications that increase when taken with PPI's |
| Warfarin | Medications that decrease when taken with PPI's |
| An infusion of esomeprazole would be administered over ___________minutes. | 10 to 30 |
| Which statement by the nursing student about the mechanism of action of proton pump inhibitors (PPIs) requires further intervention? | “PPIs work by blocking histamine2 receptors, which reduces gastric acid secretion.” Histamine2 receptor blockers like ranitidine, not PPIs, work to block histamine2 receptors. |
| In which time frame would a patient expect to experience effects from esomeprazole? | 1 hour Esomeprazole’s onset of action is 1 hour, which is when the patient can expect to experience some effects from the drug. |
| Which medical conditions would a nurse recognize that oral esomeprazole may be used to treat? | GERD, Duodenal ulcers , NSAID-induced ulcers & Zollinger-Ellison syndrome are approved condition for treatment with esomeprazole. |
| Which patients would a nurse determine require cautious use of or avoidance of esomeprazole? | 70 y.o. Asian w/ HTN - older adults & Asian descent (increases risk for dementia) require caution pt w/ osteoporosis – increase risk for hip, wrist, & spine fx pt breastfeeding – not to take PPIs pt w/ alcoholic cirrhosis - hepatic impairment |
| Which outcome would a nurse anticipate from the drug interaction that may occur in a patient who is receiving diazepam and has been newly prescribed omeprazole? | Diazepam’s half-life is increased by 130% when given concomitantly with omeprazole. Therefore the serum concentration of diazepam is increased. |
| A patient who is receiving omeprazole has been prescribed clopidogrel following stent placement. Which outcome does a nurse alert the health care provider about resulting from the drug interaction? | Evidence indicates that clopidogrel’s activation may be decreased when given with omeprazole. As a result, its antiplatelet effects may be reduced. |
| 93 y/o w/ GERD is prescribed esomeprazole. Pt immobile in a SNF, is frail, and experienced a stroke a year ago. Which adverse effects of esomeprazole will the nurse be concerned about? | Dementia and older pt, PNA (esp. if immboile), osteoporosis (esp. stroke victims & frail pt), hip or vertebral fx (esp. after stroke)- concern w/ PPI therapy, is a concern with PPI therapy, particularly as this patient is immobile. |
| Which statement regarding the pharmacodynamic profile of omeprazole is accurate? | Omeprazole has an elimination half-life of 0.5 to 1 hour. |
| Histamine stimulates gastric acid secretion by action of histamine2 receptors found in the _________ | stomach |
| Histamine2 blockers inhibit the binding of histamine to the histamine2 receptors, which ___________ gastric acid secretion. | decreases |
| These drugs are commonly referred to as H2RAs and H2 ____________________. | receptor blockers |
| Histamine has the capability to bind to two different types of receptors, histamine1 and histamine2. Histamine2 receptor blockers, the drugs utilized in the treatment of ___________, competitively block histamine2 receptors on the stomach’s parietal cells | duodenal and gastric ulcers |
| Histamine | prevent reflux esophagitis and decrease acidic gastric secretions. |
| _______________ can be administered orally, intramuscularly, or intravenously. | Cimetidine and ranitidine |
| _______________ is less potent than famotidine but 5 to 12 times more potent than cimetidine. | Ranitidine |
| Both cimetidine and ranitidine are well absorbed through the ________________________ administration. Food slows the absorption but not the overall effect of cimetidine; ranitidine’s absorption is not affected by food. | gastrointestinal (GI) tract with oral (PO) |
| Cimetidine crosses the blood-brain barrier with difficulty. Ranitidine can affect the__________________ however, the impact is minimal. | central nervous system (CNS); |
| Both cimetidine and ranitidine are metabolized in the ________. | liver |
| Both cimetidine and ranitidine are primarily excreted in the __________. | urine |
| Accumulation of cimetidine and ranitidine can occur with ______ impairment, and dosages should be reduced in these patients. | renal |
| The stomach’s parietal cells contain histamine2 receptors that, when triggered, will secrete _____________ | gastric acid. |
| The concentration of __________________________ is decreased when the histamine2 receptors are obstructed by H2RAs. | hydrogen ions and gastric acid |
| Onset: 30mins Peak: 45- 90mins Duration: 4-5 hours Half-life: 1.5 - 2 hrs | Cimetidine (PO) |
| Onset: unavailable Peak: 2-3 hours Duration:8-12 hours Half-life: 2-3 hours | Ranitidine (PO) |
| Both cimetidine and ranitidine may be used to aid in the healing of ________________________ | duodenal and gastric ulcers. |
| Ranitidine can also be used for prophylaxis of ______________ ulcers. | recurrent |
| Low doses of cimetidine may be needed for the prevention of ulcer ______________. | recurrence |
| Histamine2 receptor blockers have several conditions such as _______________ _______________ ____________ __________ | Gastric and duodenal ulcers GERD Heartburn, acid indigestion & sour stomach Zollinger-Ellison syndrome |
| Zollinger-Ellison syndrome is associated with oversecretion of gastric acid, usually due to a __________________ Ranitidine is the preferred H2RA for hypersecretory states. | gastrin-producing tumor. |
| Histamine2 blockers are generally well tolerated. However, pre-administration nursing assessment is important and should include: | • Pain ie: type, duration, severity, frequency, & location • Ulcer symp ie: epigastric pain, intensity, & aggravating & relieving factors • Fluid & electrolyte status • Renal & hepatic function • Mental status • Pregnancy/lactation status |
| Absolute contraindication for cimetidine & ranitidine includes hypersensitivity to the medication. | hypersensitivity |
| Use with caution in patients who have renal or hepatic disease, geriatric patients, and those with ___________________. | organic brain syndrome |
| Avoid use of ranitidine for pregnant women, breastfeeding mothers, and children under the age of ____. | 12. |
| Use caution with ranitidine in patients with hypersensitivity to other histamine2 receptor blockers, in those with _____________ impairment, and in older adults. | renal/hepatic |
| Drugs such as warfarin, phenytoin, theophylline, and lidocaine may result in increased levels of these drugs when given with _______________. | cimetidine |
| Cimetidine and ranitidin should be administered just before meals and at ______________ to decrease food-induced acid secretion. | bedtime |
| It is important to keep in mind that older adults have less gastric acid and therefore require ________________ of histamine2 blockers (ie: Cimetidine and ranitidin). | decreased doses |
| Cimetidine can be given PO, IV or IV continuous infusion | TRUE |
| Ranitidine can be given PO | PO given after evening meal or QHS |
| Side Effects and Adverse Effects of Histamine2 Blockers (ie: cimetidine and ranitidine) | an elevation of gastric pH risking PNA (watch out for PNA s/sx) |
| Ranitidine Side Effects and Adverse Effects | Adverse effects include hepatotoxicity. |
| Cimetidine Side Effects and Adverse Effects | Rare but serious adverse effects: Seizures, dysrhythmias, agranulocytosis, thrombocytopenia, neutropenia, aplastic anemia, exfoliative dermatitis, pneumonia |
| More common side effects of Cimetidine: | Confusion, headache, diarrhea |
| Patients should be taught that, while uncommon, histamine2 blockers can have side effects. Some of these include ___________________________ | itchy skin, decreased sexual drive, impotence, constipation, dizziness, headache, skin rash, and breast enlargement in males. |
| Antiemetic drugs are used to relieve ____________________ | nausea and vomiting |
| Vomiting center triggers the reflex of nausea and vomiting. There are several areas in the body, including the gastrointestinal (GI) tract, the inner ear, and the cerebral cortex that can send signals to the __________________ trigger zone. | chemoreceptor |
| A benzodiazepine, lorazepam, is occasionally used to indirectly control nausea and vomiting. This class is almost always used in conjunction with a ________________________. | serotonin antagonist or glucocorticoid |
| Antihistamine antiemetics are considered the _________ antiemetics | safest |
| Absorption: Well absorbed in the GI tract Distribution: Widely distributed Metabolism: In the liver Excretion: In the urine | prototype antihistamine is meclizine |
| Antihistamines (histamine1 [H1] receptor blockers), such as meclizine, block cholinergic stimulation of the __________________________ systems. | vestibular and reticular |
| Onset: 1 hr Peak: Unavailable Duration: 8-24 hr Half-Life: 6 hr | Pharmdynamic profile of meclizine |
| Scopolamine is the primary anticholinergic that is used as an antiemetic, primarily in the treatment of _______________ | motion sickness |
| Scopolamine is most commonly prescribed as a transdermal patch that is applied __________________. | behind the ear |
| Absorption: Absorbed through the skin Distribution: Unknown Metabolism: In the liver Excretion: In the urine | Scopolamine pharmkinetics |
| Anticholinergics, such as scopolamine, work by binding to acetylcholine receptors deep within the vestibular nuclei of the brain. This action blocks the nausea-inducing signal from communicating to the _______________ pathway. | vomiting |
| Scopolamine is commonly used in the prevention of motion sickness as well as in the prevention of ____________ nausea and vomiting. | postoperative |
| Onset: 1-2 hr Peak: 6-8 hr Duration: 72 hr Half-Life: 8-9.5 hr | Scopolamine pharmdynamic profile |
| Dopamine antagonists, or antidopaminergics, are commonly used antiemetics. These drugs have antihistamine and anticholinergic properties. The prototype dopamine antagonist is ________________. | promethazine |
| Absorption: Easily absorbed through the GI tract Distribution: Highly protein bound Metabolism: In the liver Excretion: In the urine and feces | promethazine pharmkinetics |
| Onset: Oral (PO) 15-60 min Peak: Unknown Duration: 4-12 hr Half-Life: 9-16 hr | promethazine pharmdynamic profile |
| Because Ondansetron class does not block dopamine receptors, ondansetron does not cause ________________________ sympt. | extrapyramidal |
| Ondansetron blocks the ________________ receptors in the chemoreceptor trigger zone & vagal nerve terminals in the GI tract, which suppresses N&V. | serotonin |
| Pharmacokinetics of Ondansetron | Absorbs easy Distributes 70% protein bound Metabolizes in the liver Excreted in the urine and feces |
| Pharmacodynamic Profile: Ondansetron | Onset: IV within 30mins Lieak: IV 1 hr Duration: IV 6-12 hrs Half-life IV 3-5 hours |
| Glucocorticoids can be administered intravenously for short periods to ___________ vomiting. | suppress |
| The two _______________ that are currently used as antiemetics are dexamethasone and methylprednisolone. | glucocorticoids |
Created by:
Monisha0517