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Henry Ford Pharm test with complete
solution
1. 6 rights of medication administration: Right drug Right dose
Right patient Right route Right time Right documentation
2. Right Drug: Proper identification of the ordered drug is required. Check medication against the physicians order form. As a Registered Nurse, you have the
responsibility before administering any medication, to ensure that the dose and drug is appropriate for the patient. You also have the responsibility to clarify orders, which are unclear or seem inappropriate for the clinical condition of the patient.
3. Right Dose: The RN is responsible for checking the dosage of the drug, doing the appropriate calculations or
conversions, and knowing the usual dosage.
4. Right Patient: Proper identification of the patient is required before medication is administered. HFHS acceptable method for confirming identification consists of
checking the patients first and last name and medical record number (MRN) on the identification band with the name and MRN on the Medication Administration Record (MAR).
5. Right Route: Route of administration should be part of the physicians order. The RN is responsible for
preparing and administering medications correctly by consulting the accompanying instructions from the pharmacy or drug company.
6. Right Time: The RN is responsible for administering medications according to scheduled times if that is how
the order is written. Instructing patients on the timing of self-administered drugs at home is also an important function for nurses. Instruct using exact times such as "take at 8: in the morning with food and 5:00 in the evening with food" rather than "take at meal times" since meal times can vary with ditterent cultural groups.
7. Right Documentation: The RN is responsible for documenting the administration of the prescribed
2 / 29 medication with the information required in the appropriate location such as the Medication Administration Record (MAR) within the Electronic Health Record.
8. In addition to the 6 rights there are some additional steps which include:: Drug
information Patient information Distraction Communication
9. Patient education: -the names of medications and how to pronounce them
-what the medications do -what they look like -how and when medications should be taken -possible side ettects and food/drug interactions
10. Who may issue a verbal order?: -Licensed independent provider (MD, DO, NP, or DDS)
-Other licensed healthcare professional (physician assistant) as a delegated act of a licensed independent prescriber
11. When is a verbal order used?: -true emergencies
-when issuing a written or electronic order is no feasible (e.g. during sterile procedures)
12. Who is permitted to receive a verbal order?: Physician Registered Nurse
Physician Assistant Pharmacist Respiratory Therapist
13. Verbal orders are not to be used under any circumstances for the prescrip-
tion of:: antineoplastic agents
4 / 29 Serious Adverse Reactions: Neutropenia, thrombocytopenia, hepatotoxicity, superinfection, hemolytic anemia, anaphy- laxis. Nursing Considerations: -ettectiveness reduced with antacids, iron salts and foods high in calcium -give 1 hour before meals or 2 hours after meals -give with a full glass of water. adequate water should be taken with each dose to prevent irritation of the esophagus Patient Education: -warn to stay out of the sun, photosensitivity manifested by exaggerated sunburn -Do not use tetracyclines during tooth development, i.e., last trimester of pregnancy, neonatal period, and childhood until age 8- may cause permanent discoloration of teeth and may inhibit fetal skeletal growth. -Do not take dairy products, iron supplements, multivitamins, calcium supplements, antacids or laxatives within 2 hours of taking tetracyclines. These products may reduce the ettectiveness of tetracyclines. -Throw away any unused tetracycline when it expires or when it is no longer needed. Do not take any tetracyclines after the expiration date printed on the label. Expired tetracyclines can cause a dangerous syndrome resulting in damage to the kidneys. -Stop taking the tetracycline and seem emergency medical attention if the patient experiences serious side ettects such as an allergic reaction, severe headache, vision changes or confusion, liver damage, bleeding or bruising, or severe fatigue. -Inform doctor if any less serious side ettects occur including nausea, vomiting, increased sensitivity of the skin to sunlight, swollen tongue, or yeast infection.
17. Aminoglycosides: Amikacin, Gentamycin (Garamycin), Streptomycin, Tobramycin
Indications: Aminoglycosides are antibiotics used to treat many ditterent infections including serious infections. Infections such as cirrhosis, gonorrhea, pneumonia, septicemia, and urinary tract infections may be treated with aminoglycosides. Serious Adverse Reactions: Nephrotoxicity, ototoxicity, agranulocytosis, thrombocytopenia, neurotoxicity. Nursing Considerations: -Nephrotoxicity is a serious side ettect of aminoglycosides. If these side ettects are present, the physician must be contacted before administering this medication. Risk increases in patient with poor renal function and the elderly. Monitor patient's BUN, creatinine, increase/decrease in frequency of urination, and increased thirst for signs of nephrotoxicity. Nephrotoxicity is limited if given for less than 5 days.
5 / 29 -Monitor patient for signs of ototoxicity. This may include tinnitus, hearing impairment, and vestibular symptoms such as dizziness, nystigmus, vertigo, and ataxia. Patient Education: -Do not take aminoglycosides without first talking to your doctor if you have: sulfite sensitivity, kidney disease, hearing loss or loss of balance due to ear problems, parkinsons disease or a neuromuscular disorder such as myasthenia gravis. -Do not use aminoglycosides without first talking with your doctor if you are pregnant or could become pregnant during treatment. -Aminoglycosides may cause damage to the kidneys and/or nerves. Kidney function and drug levels in the blood may be monitored with blood tests during treatment. -Tell your doctor if you experience hearing loss, dizziness, numbness, skin tingling, muscle twitching, or seizures, which may be signs of nerve damage.
18. Quinolones: Ciprofloxacin (Cipro), Levofloxacin (Levaquin)
Indications: Quinolones are used to treat many ditterent types of infections such as bronchitis, community acquired pneumonia, chronic bacterial prostatitis, UTI, and sinusitis. Serious Adverse Reactions: Anaphylaxis, hypersensitivity reaction, phototoxicity, superinfection, increased ICP, seizures. Nursing Considerations: -Use with caution in renal or liver failure, geriatrics and with seizure disorders -Administer 2 hours before or after antacids, iron supplements, and multivitamins -Encourage plenty of fluids to minimize risk of crystalloids -Pediatric use not recommended -Avoid using with drugs used to treat heart rhythm disturbances (irregular heartbeats) with drugs such as quinidine (Cardioquin, Quinidex, Quinaglute, others), procainamide (Pronestryl, Procan SR, others), amiodarone (Cordarone, Pacerone, others), sotalol (Betapace), and others. Combinationof quinolones and these drugs may prolong the QT interval and lethal dysrhythmias may result. Patient education: -Before taking levofloxacin, tell your doctor if you: have kidney disease, have a seizure disorder, have a heart condition known as prolongation of the QT interval, have a slow heart rate that is considered a medical condition, have low levels of potassium in your blood, are being treated for heart rhythm disturbances (irregular heartbeats) with drugs such
7 / 29 -prolonged serum half-life (15 hours) and reduced total clearance in the elderly. Patient Education: -before using cephalosporins, tell your doctor if you have had kidney disease, liver disease, bleeding or clotting problems, gastrointestinal disease such as colitis or gallbladder problems -May decrease ettectiveness of birth control pills and a second method of birth control while taking penicillin may be necessary to ensure protection from unintended pregnancy -do not use cephalosporins if you have ever had an allergic reaction to penicillin without first consulting physician -seek emergency medical treatment if patient experiences signs and symptoms of an allergic reaction such as shortness of breath, hives, swelling of the lips, face or tongue, rash, or fainting
20. Macrolides: Erythromycin, azithromycin (Zithromax), clarithromycin (Biaxin), erythromycin/sulfisoxazole
Indications: Macrolides are used to treat many ditterent types of bacterial infections, such as tonsillitis, bronchitis, pneumonia, whooping cough, legionnaires disease, chlamydia, gonorrhea, skin infections, and others Serious Adverse Reactions: Anaphylaxis, hepatotoxicity, thrombophlebitis, ventricular arrhythmias, bradycardia, hy- potension Nursing Considerations: -Monitor the patient for an allergic reaction with the combination erythromycin and sulfisoxazole if the patient has ever had an allergic reaction to diuretics, a sunscreen containing PABA, or sulfonamide -Monitor for signs of overdose that may include decreased appetite, nausea, vomiting, diarrhea, dizziness, headache, abdominal discomfort, drowsiness, fever, and unconsciousness -give medication with a full glass of water and encourage increase fluid intake daily unless contraindicated -Monitor patient for a regular pulse or arrhythmias if on a cardiac monitor -if I monitor, be sure to measure the QT interval and notify physician if the interval is prolonged Patient Education: -take the medication exactly as ordered by the physician -do not take is pregnant without consulting your physician
8 / 29 -do not take Seldane, Hismanal, Propulsid, or Orap. These medication may interact resulting in dangerous or life-threat- ening a regular heartbeats -avoid prolonged exposure to sunlight. The medication may increase the sensitivity of the skin to sunlight. Use a sunscreen and wear protective clothing when exposure to the sun is unavoidable
21. Sulfonamides: Trimethoprim/sulfamethoxazole (Bactrim DS, Bactrim SS, Septra DS)
Indications: so far no minds are used to treat infections such as urinary tract infections, bronchitis, ear infections (otitis), travelers diarrhea, and pneumocystic carinii pneumonia Serious Adverse Reactions: hypersensitivity reactions, such as Stevens Johnson syndrome. Hematopoetic disorders, such as acute hemolytic anemia. Urinary tract abnormalities such as the deposit of sulfonamide crystals within the tissue of the urinary tract. Hepatitis rarely; focal or dittuse necrosis of the liver Nursing Considerations: Monitor for overdose symptoms which may include nausea, vomiting, decreased appetite, diarrhea, headache, yellowing of the skin arise, decreased urine production, bloody urine, and coma Patient Education: -this medication attects folic acid in your body, which is necessary for the normal development of a baby. Do not take sulfamethoxazole and trimethoprim without first talking to your doctor if you are pregnant -Sulfamethoxazole and trimethoprim passes into breast milk and may harm a nursing baby. Do not take this medication without first talking to your doctor if you are breast-feeding a baby. -Sulfamethoxazole and trimethoprim is not approved for use in children younger than two months of age -take each dose with a full glass of water -avoid prolonged exposure to sunlight. Sulfamethoxazole and trimethoprim May increase the sensitivity of your skin to sunlight. Use sunscreen and wear protective clothing when I get exposure to the sun is unavoidable -stop taking sulfamethizole and trimethoprim and seek emergency medical attention if you experience any of the following serious side ettects: allergic reaction (diflculty breathing, closing of your throat, swelling of your lips, tongue, or face, or hives); unusual bleeding or bruising, or yellow skin or eyes
22. Antituberculars: Isoniazid (INH), Rifampin (Rifadin), Mycobutin (Rifabutin)
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- CMV: used to treat and prevent infections caused by cytomegalovirus. This infection usually occurs in patients who have suppressed immune system's, such as patients with AIDS and organ transplant patients. -HIV: used to treat the human immunodeficiency virus, which causes the acquired immunodeficiency syndrome. These medications are called reverse transcriptase inhibitors. They inhibit the reproduction of HIV. -Hepatitis: used to treat chronic hepatitis B -herpes colon used to treat infections caused by herpesviruses. Illnesses caused by herpesviruses include genital herpes, cold sores, shingles, and chickenpox Serious Adverse Reactions: thrombocytopenia, neutropenia, pancytopenia, sepsis, nephrotoxicity Drug Interactions: antiviral medication can react with many drugs including over-the-counter and herbal medication. Contact the pharmacy for specific drug interactions. Nursing Considerations: -lactic acidosis and severe liver problems including fatal cases have been reported with antivirals. Report to the physician if the patient experiences nausea, vomiting, shortness of breath, weakness in arms and legs, jaundice of skin, eyes are palate, or pain in the upper right hand quadrant of the abdomen. -Monitor patients for signs and symptoms of pancreatitis and bone marrow suppression Patient Education: -viral infections are contagious and can infect others, even during treatment. Avoid letting infected areas or body fluids come in to contact with others. Frequent handwashing will help to prevent transmission.
11 / 29 -avoid high risk activities such as the sharing of needles and unprotected sexual activity -avoid alcohol and take with these medications. Alcohol may increase the risk of liver or pancreatic damage
24. Anti-fungal Agents: Amphotericin B, Nystatin (Mycostatin), Fluconazole (Difulcan)
Indications: Antifungal medication's are used to treat fungal infections of the mouth, throat, esophagus, vagina, urinary tract, blood, and pneumonia. They are also used to prevent fungal infections from occurring in people with suppressed immune system's such as chemotherapy patients, organ transplant patients, and AIDS patients Serious Adverse Reactions: -Nystatin: hypersensitivity (rare)
- Amphotericin B: electrolyte imbalance (severe hypokalemia), nephrotoxicity, renal failure, anaphylaxis
- Fluconazole: hepatotoxicity, Stevens Johnson syndrome, angioedema, seizures, leukopenia Nursing Considerations: -Nystatin: Used for treatment of cutaneous and mucocutaneous infections caused by candida albicans. Available in cream, I meant, powder, vaginal tablets and oral tablets. Immuno suppressed patients or sometimes instructed to suck on oral tablets because this provides prolonged contact with oral Mikasa. Contact the pharmacist for other drug interactions including over-the-counter and herbal medications -Amphotericin B: indicated for treatment of any type of progressive fungal infection that does not respond to conven- tional treatment. Monitor kidney function for toxicity I.e. creatinine. If line must be flushed, do not use heparin or saline use D5W
25. Angiotensin Converting Enzyme Inhibitors (ACE inhibitors): Benazepril, Captopril
(Capoten), Enalapril (Vasotec), Lisinipril (Prinivil) Indications: treatment of hypertension, either alone or in combination with other antihypertensive agents; adjunctive therapy and treatment of CHF; treatment of left ventricular dysfunction after myocardial infarction Serious Adverse Reactions: Angeo Adema, severe hypertension, acute renal failure, severe hyperkalemia Nursing Considerations: -Monitor for angioedema (swelling of lips, tongue, or glottis). If patient has any of the symptoms, hold the dose and notify the physician immediately
13 / 29 -assess orthostatic blood pressures for complaints of dizziness when going from a lying or sitting to standing position -Monitor creatinine and BUN Patient Education: -take exactly as directed and do not discontinue without consulting physician -take first dose at bedtime -Consult physician before using NSAIDS -May cause dizziness, fainting, and/or lightheadedness -Report chest pain or palpitations, unrelenting headache, swelling of extremities, face or tongue, diflculty in breathing, or unusual cough
27. Cardiac glycosides (digitalis preparation's): Digoxin (Lanoxin)
Indications: did Jackson is used for the treatment of CHF and to slow the ventricular rate in tachyarrhythmias such as atrial fibrillation, atrial flutter and supraventricular tachycardia Serious Adverse Reactions: AV block, bradycardia, ventricular arrhythmia, thrombocytopenia (rare), delirium, hallucina- tions Nursing considerations: -observe patients for non-cardiac signs of toxicity such as anorexia, vision changes (blurred, yellow halos), confusion, depression, anorexia, and fatigue -Monitor for changes in pulse rate, rhythm and blood pressure. Take apical pulse before administering. Usual parameters: pulse under 60 or greater than 120 hold those and notify physician -Monitor patient potassium levels as hypokalemia may potentiate the risk for digoxin toxicity -The antidote for digoxin toxicity is Digibind -elderly patients are at greater risk for developing digoxin toxicity Patient Education: -take as directed-do not discontinue without consulting physician
14 / 29 -maintain adequate dietary intake of potassium to reduce toxicity -take pulse at the same time each day and follow physicians orders of when to call -Notify physician if there was a loss of appetite, nausea and vomiting, persistent diarrhea, swelling of extremities, palpitations, yellowing or blurred vision, mental confusion, depression, or fatigue
28. Coronary Vasodilators/Antianginals: Nitrites, Nitrates: Nitroglycerin [NTG] (Nitrobid, Nitrostat,
Nitro-Dur) Isosobide dinitrate (Isordil), Isosorbide Mononotrate (Imdur) Indications: treatment of angina pectoris, CHF, pulmonary hypertension, hypertensive emergencies Serious Adverse Reactions: thrombocytopenia, orthostatic hypotension Common Reactions: hypotension, migraine headache Nursing Indications: -IV must be prepared in glass bottles and use special sets intended for NTG -transdermal patch labeled as mg/hour -transdermal patches may be ordered to be removed at night to allow for a nitrate free period -do not crush sublingual drug product -Isorbide mononitrate is a sustained release nitrate -Viagra potentiates the hypotensive attects of nitrates; concurrent use is contra indicated -beta and calcium channel blocker's, antihypertensive, and antidepressants may enhance hypotensive ettects Patient Education: -patient teaching related to NTG sublingual: tell patient to always carry bottle with them. Keep them in original dark glass bottle and replace six months after opening. Tell patient to put one tablet under tongue at first sign of anginal attack. Advise patient to sit or lie down for 10 to 15 minutes after taking drug to decrease side ettects. Instruct patient to take additional SL tablets (up to three) at five minute intervals if pain is not relieved. If pain is still present after 15 minutes, call 911 -use caution with elderly patients- risk of hypotension
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33. Principles of hypertension treatment: To treat blood pressure less than 140/90 or blood pressure less than 130/60 in patients with
diabetes or chronic kidney disease. Majority of patients will require two medication's to reach a goal
34. Initial therapy options for heart failure: Thiazide diuretic, beta blocker, ACE inhibitor, angiotensin receptor blocker, aldosterone antagonist
35. Initial therapy options for post myocardial infarction: Beta blocker, ACE inhibitor, aldos- terone antagonist
36. Initial therapy options for high CVD risk: Thiazide diuretic, beta blocker, calcium channel blocker, ACE inhibitor
37. Initial therapy options for chronic kidney disease: ACE inhibitor, angiotensin receptor blocker
38. Initial therapy options for diabetes: Thiazide diuretics, beta blocker, angiotensin receptor blocker, calcium channel blocker, ACE inhibitor
39. Initial therapy options for recurrent stroke prevention: Thiazide diuretic, ACE inhibitor
40. Indications for beta blockers: Beta blockers are indicated for treatment of hypertension, post myocardial infarction, improving cardiovascular
outcomes with patient who have underlying cardiovascular disease and are undergoing non-cardiac surgery, treatment of atrial fibrillation, unstable angina, and heart failure (cardiac selective)
41. Indications for alpha blockers: Indicated for treatment of hypertension
42. Adverse reactions of beta blockers and common reactions: Bronchospasm, hypoten- sion-severe, cardiac failure
Common reactions: hypotension, dizziness, nausea, somnolence, confusion
43. Serious reactions to alpha blockers: Arrhythmias
44. Common Reactions of alpha blockers: Dizziness, headache, orthostatic hypotension, fatigue
45. Nursing indications for beta blockers: -minimize risk of bradycardia with initiation of treatment with a low-dose and slow upward titration
-administer medication with food -Monitor blood pressure and heart rate
17 / 29 -Does not work well in elderly patients. Response rates only 20% of 80% -beta blockers may mask symptoms of hypoglycemia
46. Patient education for beta blockers: -instruct patient to report lightheadedness/dizziness asso- ciated with therapy
-inform patients not to abruptly stop taking antihypertensive medications -encourage increase fluid intake. Increased dietary both for patients as constipation is common -do not take with aunt acids and avoid alcohol or over-the-counter medication before consulting physician -if diabetic, monitor serum glucose closely -because fatigue, dizziness or postural hypotension, use caution when changing position from lying or sitting to standing -May cause alteration in sexual performance -Report unresolved swelling of extremities, diflculty breathing, or new cough
47. Antiarrhythmics: Amiodarone, Procainamide (Pronestyl) Lidocaine hydrochloride (Xylocaine)- IV only Indications: lidocaine IV is used for
acute treatment of ventricular arrhythmias due to myocardial infarction, cardiac manipulation, and digitalis intoxication. Amiodarone and procainamide are used to treat both atrial and ventricular arrhythmias. Adverse Reactions: Amiodarone- ventricular arrhythmia, prolonged QT, bradycardia-severe, hypotension-severe, CHF, cardiogenic shock(IV), elevated liver function tests, hypothyroidism, pulmonary fibrosis. Common reactions: Amiodarone- Photo sensitivity, may result in a bluish coloring of the skin, fatigue Adverse reactions: Procainamide- ventricular fibrillation, a systole, seizures, thrombocytopenia Common reactions: Procainamide- hypotension, bradycardia Serious Reactions: lidocaine- seizures, respiratory arrest, worsened arrhythmia, status asthmaticus, heart block, brady- cardia, coma Common reactions: lidocaine- Tremor, confusion, hypotension, blurred vision Nursing Indications: -these drugs have a narrow therapeutic index. Monitor apical rate and blood pressure for bradycardia and hypotension -half-life increase in elderly due to decrease in both renal and hepatic function with age
19 / 29 -numerous drugs interact with warfarin. The ettect may be a decreased anticoagulant attect and increase bleeding tendency, or an enhanced anticoagulant attect. Check with the pharmacist regarding the drug interactions. Ensure patients have discharge follow up by anticoagulation clinic when discharged home on Coumadin Nursing indications for heparin: -antagonist is protamine sulfate. An overdose of heparin may be reported immediately upon discovery. Drug withdrawal may be suflcient to manage the overdose. If not, the administration of protamine sulfate is done by the physician -heparin is never administered I am due to pain, irritation, and hematoma formation -do you not massage the site if given subcutaneous Nursing indications for lovenox: -administer by deep subcutaneous injection to the left or right anterolateral and left or right posterolateral abdominal wall -do not expel air bubble from the shrine prior to injection -do not rub injection site Patient education: -do not take any medication that your physician is not aware of and follow diet and activity is recommended by your physician -you may have a tendency to bleed easily while taking this drug -brush teeth with soft brush, floss with waxed floss, use electric razor, and avoid scissors or sharp knives and potentially harmful activities -Report chest pain, persistent constipation, unusual bleeding or bruising, pain and joints are back, or numbness/tin- gling/swelling/pain at injection site -increased risk of bleeding if combine with chamomile, garlic, ginger, ginko, or ginseng therapy
49. Non-opioid analgesics: antipyretics: Acetylsalicylic acid (aspirin)
-has anti-inflammatory, anticoagulant, analgesic, and anti-pyretic actions. Inhibits prostaglandin synthesis -irritating to gastric mucosa. Instruct patient to take with milk or food. Should be given with caution for patients with peptic ulcer's. High risk for bleeding when given with anticoagulant therapy. -toxicity is indicated by tinnitus (ringing in the ear) Acetaminophen (Tylenol) -non irritating to gastric mucosa
20 / 29 -has analgesic and anti-pyretic actions -toxic reaction includes liver damage -do not exceed 4 g per day -check OTC drugs patient may be taking for other sources of acetaminophen
50. Non steroidal anti-inflammatory drugs (NSAIDs): Ibuprofen (Motrin), Naproxen (Naprosyn), indocin (Indomethacin),
ketorolac (toradol) -has anti-inflammatory, analgesic, anti-pyretic attects -can be irritating to the gastric mucosal. Take with milk and or food -used cautiously with patients with history of peptic ulcer -attects coagulation (platelet aggregation) -use cautiously with the elderly. As many as 60% can develop peptic ulcer ration and or hemorrhage asymptomatically. Use the lowest possible dose for shortness. Possible if necessary to use NSAIDS and elderly patients -avoid taking NSAIDS with ACE inhibitors
51. Opioid analgesics: Codeine, morphine, opium, and various opium derivatives
1. Use caution: respiratory depression may occur in elderly
2. Codeine: mild to moderate pain, duration of action is 4 to 6 hours, very constipating monitor bowel function, come in side ettects are dizziness and sedation
3. Combination dosage forms
-Tylenol number one acetaminophen 300 mg and codeine phosphate 7.5 mg -Tylenol number two acetaminophen 300 mg and codeine phosphate 15 mg -Tylenol number three acetaminophen 300 mg and codeine phosphate 30 mg
