Pharmacology

Chapter 43
P-1
Notes/flashcards from lecture

How do ulcers occur?

results from reflux of acidic gastric secretions into esophagus due to an incompetent cardiac sphincter

What does a gastric ulcer result from?

results from a breakdown of gastric mucosal barrier

What does a duodenal ulcer result from?

hypersecretion of acid

What does a stress ulcer result from?

results from trauma, burns, major surgery

What are the predisposing factors of peptic ulcers?

helicobacter pylori
mechanical disturbances
genetic influences
environmental influences
drugs
stress ulcer following a critical situation

What are the symptoms of peptic ulcers?

gnawing, aching pain

How long does treatment last for ulcers?

7-14 days

What does treatment consist of for ulcers?

7-14 days of drug treatment followed by 6 weeks of acid suppression (H2 blocker)

What is GERD?
inflammation of esophageal mucosa caused by reflux of gastric acid content into the esophagus

What is the cause of GERD?

Incompetent lower esophageal sphincter
What can accelerate the disease process of GERD?
Smoking

What is the medical treatment for GERD?

PPIs
H2 blockers

What are some nonpharmacologic measures for GERD and Peptic Ulcer?
avoid tobacco and alcohol
weight loss if obese
avoid hot spicy, greasy foods
Take NSAIDs and oral glucocorticoids with food
Sit upright during and after meals
do not eat before bedtime
wear loose-fitting clothing

What is the action of tranquilizers?

reduce vagal stimulation, decrease anxiety
What are the side effects of tranquilizers?
edema
ataxia
confusion
EPS
agranulocytosis

How do anticholinergics treat ulcers?

inhibit acetylcholine and block histamine and HCL
delay gastric emptying

What are some examples of an anticholinergic that treats ulcers?

clidinium-chlordiazepoxide
glycopyrrolate
propantheline

When should you take anticholinergics

before meals to decrease acid secretion

if you are on an anticholinergic and antiacid, how do you need to space them?
take antacids 2 hours after anticholinergic meds

What are the side effects of anticholinergics?

dry mouth, dizziness, drowsiness, blurred vision, palpitations, urinary retention, constipation

What is the action of antiacids?

neutralize HCL and reduce pepsin activity

What are the side effects of sodium bicarbonate?

hypernatremia, water retention, metabolic alkalosis, acid rebound

What are the side effects of calcium carbonate?

acid rebound
hypercalcemia

What is the side effect of magnesium hydroxide?

diarrhea

What is the side effect of aluminum hydroxide?

constipation

When do you take antacids?

1-3 hours after meals and at bedtime

What are 4 examples of antacids?

sodium bicarbonate
calcium carbonate
magnesium hydroxide
aluminum hydroxide

When will patient's abdominal pain be decreased after antiulcer treatment?

1 to 2 weeks

What is the action of histamine 2 blockers?

block H2 receptors of parietal cells in stomach to reduce gastric acid secretion
promote healing of ulcer by eliminating cause
What are the side effects of histamine 2 blockers?
headaches
dizziness
constipation
impotence
decreased libido
gynecomastia

What are some examples of histamine 2 blockers?

rantidine
cimetidine
famotidine

When are histamine 2 blockers usually taken?

just before meals or at bedtime to decrease food-induced acid secretion

What is the action of proton pump inhibitors?

reduce gastric acid by inhibiting hydrogen/potassium ATPase- enzyme in the final step in acid
production

What are the side effects of proton pump inhibitors?

headaches
dizziness
edema
diarrhea
abdominal pain
constipation

What is the drug interaction between proton pump inhibitors and digoxin?
proton pump inhibitors interfere with metabolism of digoxin, oral anticoagulants, some
benzodiazepines

What is the drug interaction between proton pump inhibitors and phenytoin?
phenytoin increases effects of proton pump inhibitors

What are some examples of proton pump inhibitors?

esomeprazole
omeprazole
lansoprazole
pantoprazole

When do you usually take proton pump inhibitors?

before meals

What is an example of a pepsin inhibitor?

sucralfate

What is the action of sucralfate?

combines with protein to form thick paste covering ulcer protecting ulcer from acid and pepsin

What are the side effects of sucralfate?

constipation

When is sucralfate given?

30 minutes before meals and bedtime
should pepsin inhibitors be administered on an empty stomach or a full one?
empty

What is an example of a prostaglandin analog?

misoprostol

What is the action of misoprostol?

-suppress gastric acid secretion
-cause moderate decrease in pepsin secretion
-protect mucosa

What are the side effects of prostaglandin analogs?

diarrhea
abdominal pain
chills, shivering
Hyperthermia

asymptomatic
condition in which there is no outward evidence (symptom) that an infection is present

dysentery
condition characterized by frequent watery stools (usually containing blood and mucus), tenesmus,
fever and dehydration

dysgenusia
a persistent abnormal sense of taste

malaria
protozoal infection characterized by attacks of chills, fever, and sweating

prophylaxis
procedure or medication to prevent a disease, rather than to treat an existing disease

suppression therapy
taking the drug daily even when there are no observable acute symptoms

trichomoniasis
infection caused by the trichomonas organism; a sexually transmitted disease

tenesmus
a painful spasm of the anal sphincter, causing an urgent desire to defecate although little or no
material is passed

endemic
present continually in a particular geographic region, often in spite of control measures

antimalarial drugs
Vibramycin, Plaquenil, Sulfdoxine
Metronidazole (Flagyl)
treatment of protozoal infections

Trichomonas vaginalis
Metronidazole (Flagyl), Tinidazole (Tindamax)

toxoplasmosis
identified in the fecal matter of domestic cats

Giardia lamblia
common cause of waterborne disease in humans in the US. enters water sources through unsanitary
conditions

Anthelminic Drugs
treatment of parasitic (worms) infections

Vermox
treatment of pinworms, round worms, and hookworms

parasitic worm infestations

all family members should be treated

Quiz after lecture (with correct answers)

1. Which laboratory value will the nurse report to the health care provider as a potential adverse
response to hydrochlorothiazide?
A. Sodium level of 140 mEq/L
B. Fasting blood glucose level of 140 mg/dL
C. Calcium level of 9 mg/dL
D. Chloride level of 100 mEq/L
B. Fasting blood glucose level of 140 mg/dL

2. What is the best information for the nurse to provide to the patient who is receiving spironolactone
(Aldactone) and furosemide (Lasix) therapy?
A. "Moderate doses of two different diuretics are more effective than a large dose of one."
B. "This combination promotes diuresis but decreases the risk of hypokalemia."
C. "This combination prevents dehydration and hypovolemia."
D. "Using two drugs increases the osmolality of plasma and the glomerular filtration rate."
B. "This combination promotes diuresis but decreases the risk of hypokalemia."

3. The nurse is assessing a patient who is taking furosemide (Lasix). The patient's potassium level is
3.4 mEq/L; chloride is 90 mmol/L, and sodium is 140 mEq/L. Based on the nurse's understanding of
the laboratory results, what prescribed therapy can the nurse anticipate administering?
A. Mix 40 mEq of potassium in 250 mL D5W and infuse rapidly.
B. Administer sodium polystyrene sulfonate.
C. Administer 2 mEq potassium chloride per kilogram per day IV.
D. Administer calcium acetate, two tablets three times per day.
C. Administer 2 mEq potassium chloride per kilogram per day IV.

4. A patient taking spironolactone (Aldactone) has been taught about the medication. Which menu
selection indicates that the patient understands teaching related to this medication?
A. Potatoes
B. Lima beans
C. Chicken
D. Strawberries
C. Chicken

5. Which patient would the nurse need to assess first if the patient is receiving mannitol (Osmitrol)?
A. A 67-year-old patient with type 1 diabetes mellitus
B. A 21-year-old patient with a head injury
C. A 47-year-old patient with anuria
D. A 55-year-old patient receiving cisplatin to treat ovarian cancer
C. A 47-year-old patient with anuria

6. A nurse is caring for a patient receiving acetazolamide (Diamox). Which assessment finding will
require immediate nursing intervention?
A. A decrease in bicarbonate level
B. An increase in urinary output
C. A decrease in arterial pH Correct
D. An increase in PaO2
C. A decrease in arterial pH

7. A patient is prescribed chlorthalidone (Thalitone). What is the most important information the
nurse will teach the patient?
A. "Do not drink more than 10 ounces of fluid a day while on this medication."
B. "Take this medication on an empty stomach."
C. "Take this medication before bed each night."
D. "Wear protective clothing and sunscreen while taking this medication."
D. "Wear protective clothing and sunscreen while taking this medication."

8. A patient with acute pulmonary edema is receiving furosemide (Lasix). What assessment finding
indicates to the nurse that the intervention is working?
A. Potassium level decreased from 4.5 to 3.5 mEq/L
B. Improvement in mental status
C. Lungs clear
D. Output 30 mL/hr
C. Lungs clear

9. Which assessment indicates to the nurse a therapeutic effect of mannitol (Osmitrol) has been
achieved?
A. Decreased intracranial pressure
B. Decreased potassium
C. Increased urine osmolality
D. Decreased serum osmolality
A. Decreased intracranial pressure

10. What intervention will the nurse perform when monitoring a patient receiving triamterene
(Dyrenium)?
A. Assess urinary output every other day.
B. Monitor for side effect of hypoglycemia.
C. Assess potassium levels.
D. Monitor for hypernatremia.
C. Assess potassium levels.

11. A patient is ordered furosemide (Lasix) to be given via intravenous push. Which interventions will
the nurse perform? (Select all that apply.)
A. Administer at a rate no faster than 20 mg/min.
B. Assess lung sounds before and after administration.
C. Assess blood pressure before and after administration.
D. Maintain accurate intake and output record.
E. Monitor ECG continuously.
F. Insert an arterial line for continuous blood pressure monitoring.
A. Administer at a rate no faster than 20 mg/min.
B. Assess lung sounds before and after administration.
C. Assess blood pressure before and after administration
D. Maintain accurate intake and output record.

C; Nasal congestion
a nurse is caring for a patient with nocturnal enuresis. A physician has prescribed desmopressin
acetate to the patient. Which of the following adverse reactions to the drug should the nurse monitor
for in the patient?

A. gynecomastia
B. fluid retention
C. nasal congestion
D. breast tenderness

fludrocortisone
A patient with diabetes insipidus has been prescribed a vasopressin drug. The patient also has limited
ambulatory activities. Which of the following should the nurse be careful about while caring for the
patient?

A. examine the patient's abdomen every 15 to 30 minutes

B. give 4 glasses of water immediately after taking the drug
C. refill the water container at frequent intervals
D. measure the amount of fluid loss every 24 hours

fludrocortisone
After teaching a group of nursing students about corticosteroids, the instructor determines that the
teaching was successful when the students identify which of the following as a mineralcorticoid?

A. fludrocortisone
B. hydrocortisone
C. triamcinolone
D. betamethasone
A. blanching of the skin, nausea, and abdominal cramps
After vasopressin (Pitressin) administration, the nurse should observe the patient every 10 to 15
minutes for signs of excessive dosage, which may include what?

A. blanching of the skin, nausea, and abdominal cramps

B. nausea, diarrhea, and excessive perspiration
C. dry skin, flushing, and hypothermia
D. excessive urinary output

B. adrenal dysfunction
A nurse is preparing the medical history report of a patient who is to be administered gonadotropins.
In patients with which of the following conditions is the use of gonadotropins contraindicated?

A. underlying cranial lesions

B. adrenal dysfunction
C. Epiphyseal closure
D. sensitivity to benzyl alcohol

B. rotate sites and examine previous sites for redness and irritation
A nurse is caring for a patient who has been administered gonadotropins by the intramuscular route
for the secretion of sex hormones. The patient complains about pain after the drug is injected. Which
of the following interventions should the nurse perform for the patient?

A. observe the skin daily for localized signs of infection

B. rotate sites and examine previous sites for redness and irritation
C. instruct the patient about proper injection technique
D. report any complaints of sore throat, cough, or fever

B. glucose tolerance
A physician has ordered a nurse to administer a growth hormone through the subcutaneous route to
a patient. Which of the following tests is required to be performed at different intervals during the
treatment?

A. serum electrolyte levels

B. glucose tolerance
C. pH level of the blood
D. carbohydrate tolerance

A. vasomotor flushes
Which of the following adverse reactions could the nurse expect with the administration of
clomiphene (Clomid)?

A. vasomotor flushes
B. hypertension
C. sedation
D. edema

A. use water-based cosmetics or creams

A patient is undergoing glucocorticoid therapy at a health care facility. The patient develops acne.
What should the nurse tell the patient with acne?
A. use water-based cosmetics or creams
B. avoid the use of alcohol while taking the drug
C. Avoid exposure to infections
D. Do not recieve live virus vaccines

D. take and record vital signs every 4 to 8 hours.

A patient has been prescribed glucocorticoids for the treatment of congenital adrenal hyperplasia.
Which of the following assessments should the nurse perform for the patient?

A. Test the serum electrolyte levels

B. Observe for signs of blanching of the skin
C. Auscultate the abdomen and record the findings
D. Take and record vital signs every 4 to 8 hours

C. deficient fluid volume

A patient is receiving glucocorticoid therapy. Which nursing diagnosis would the nurse be least likely
to identify for this client?

A. Risk for injury

B. Disturbed body image
C. Deficient fluid volume
D. Risk for infection

C. take the oral drug with meals or snacks

A nurse is caring for a patient who has been undergoing glucocorticoid therapy at a health care facility
and is getting discharged. Which of the following instructions should the nurse include in the teaching
plan for the patient and family?

A. Notify the primary health care provider if glucose appears in the urine
B. Measure the amount of fluids taken each day
C. Take the oral drug with meals or snacks
D. Report any symptoms of sore throat or fever immediately

D. hypernatremia and hypokalemia

Which of the following electrolyte imbalances may be seen with mineralocorticoid administration?

A. hyponatremia and hypokalemia

B. hypocalcemia and hyperkalemia
C. hypercalcemia and hyperkalemia
D. hypernatremia and hypokalemia