Study ATI medication cards with these practice questions and answers. This guide covers drug classifications, mechanisms of action, side effects, and nursing considerations.
Q: risedronate
Answer: -class: bisphosphonate-action: decrease number and action of osteoclasts and inhibit bone reabsorption-use: prophylaxis/treatment of osteoporosis; Paget’s disease of bone-complications: esophagitis/esophageal ulceration; GI disturbances; musculoskeletal pain; visual disturbances-contraindications/precautions: clients w/ dysphagia, esophageal stricture, esophageal disorders, kidney impairment, hypocalcemia-interactions: absorption decreases when taken with calcium, iron, magnesium, antacids, OJ or caffeine
Q: lithium
Answer: -class: mood stabilizer-action: including serotonin receptor blockade-use: treatment of bipolar disorder-complications: GI distress, fine hand tremors, polyuria, weight gain, renal toxicity, goiter, hyperthyroidism, bradyrhythmia, hypotension, electrolyte imbalance, toxicity-contraindications: teratogenic-interactions: diuretics (decreases sodium which can lead to lithium toxicity), NSAIDs (increase renal absorption of lithium leading to toxicity), anticholinergics (increased polyuria)
Q: betamethasone
Answer: -class: glucocorticoid (steroid)-action: prevents release of substances that cause inflammation-use: treats inflammation and itching caused by number of skin conditions such as eczema, psoriasis, allergic reactions-complications: burning, stinging, itching, blistering
Q: oprelvekin
Answer: -class: thrombopoietic growth factors-action: increase production of platelets-use: decreases thrombocytopenia and need for platelet transfusions in clients receiving chemotherapy-complications: fluid retention, cardiac dysrythmias, eye effects, allergic reactions-contraindications: patients who have cancer of the bone marrow (can stimulate tumor growths), cautious use for patients w/ heart failure and pleural effusion-nursing admin: effectiveness can be evidenced by platelet count >50,000
Q: morphine
Answer: -class: opioid analgesic-action: activate mu receptors-use: relief of moderate to severe pain, sedation, reduction of bowel motility-complications: respiratory depression, constipation, orthostatic hypotension, urinary retention, sedation, biliary colic, nausea/vomiting, overdose-contraindications: after biliary tract surgery; clients who have asthma, are obese, are pregnant, have inflammatory bowel disease, enlarged prostate, or hepatic or renal disease-interactions: CNS depressants, anticholinergic agents, antihypertensives-nursing admin: hold dose if respirations <12/min, administer IV slowly, do not discontinue abruptly if patient has dependence, monitor PCA
Q: heparin
Answer: -class: anticoagulant-action: prevent clotting by activating antithrombin, inhibits fibrin formation-use: conditions requiring prompt anticoagulant activity (stroke, DVT), adjunct for open heart surgery or renal dialysis, prophylaxis for DVT, treatment of disseminated intravascular coagulation-complications: hemorrhage, thrombocytopenia, hypersensitivity reactions, toxicity/overdose-contraindications: low platelet counts; during/after surgery of brain, eyes, spinal cord; cautious use for patients w/ hemophilia, dissecting aneurysm, peptic ulcer disease, severe hypertension, hepatic/kidney disease, threatened abortion-interactions: antiplatelet agents (aspirin, NSAIDs)-nursing admin: use 20-22 gauge needle to withdraw meds but inject w/ 25-26; do not aspirate; apply gentle pressure 1-2 mins after injection; rotate and monitor injection sites; use electric shaver and brush with soft toothbrush
Q: ceftazidimecefazolin
Answer: -class: cephalosporin-action: destroy bacterial cell wall-use: broad-spectrum bactericidal meds w/ high therapeutic index that treat UTI, post-op infections, pelvic infections, and meningitis-complications: cross sensitivity to penicillin, allergy, hypersensitivity, anaphylaxis, bleeding tendencies, renal insufficiency, antibiotic-associated psuedomembranous colitis-contraindications: allergy to penicillin, renal impairment or bleeding tendencies-interactions: disulfiram reaction (intolerance to alcohol) occurs w/ simultaneous use of alcohol; probenecid delays renal excretion-nursing admin: complete entire course of therapy, take w/ food
Q: amoxicillin/clavulanate
Answer: -class: broad-spectrum penicillin-action: destroy bacteria by weakening cell wall-use: treat infections due to gram-positive and gram-negative-complications: allergies, renal impairment-contraindications: allergy to penicillin, cephalosporins, impenem; cautious use for renal impairment, older adults or young children-interactions: aminoglycosides, probencid-nursing admin: take with meals, complete entire course of therapy, use additional contraceptive methods
Q: mannitol
Answer: -class: osmotic diuretic-action: reduce intracranial pressure and intraocular pressure by raising serum osmolality and drawing fluid back into vascular and extravascular space-use: prevent kidney failure during situations such as hypovolemic shock; decrease incracranial pressure; decrease intraocular pressure; promote sodium retention and water excretion in patients with hyponatremia and fluid volume excess; oliguria phase of acute kidney injury-complications: heart failure (pulmonary edema), rebound increased intracranial pressure, fluid and electrolyte imbalances (metabolic acidosis)-contraindications: intracranial bleed, anuria, severe pulmonary edema, severe dehydration, renal failure; cautious use for patients with heart failure, pregnant or breast feeding, renal insufficiency, electrolyte imbalances-interactions: lithium (lithium excretion increased), cardiac glycosides (increase risk for hypokalemia)
Q: diazepamchlordiazepoxide
Answer: -class: benzodiazepine-action: enhance inhibitory effects of GABA in CNS-use: Generalized anxiety disorder-complications: CNS depression, anterograde amnesia, toxicity, paradoxical response, withdrawal-contraindications: clients with sleep apnea, respiratory depression, glaucoma; short term use due to dependence; cautious with older adults or those with liver disease-interactions: CNS depressants, grapefruit juice, high fat meals-nursing admin: taper dose over weeks when ending use; antidote is flumazenil
Q: isoniazid
Answer: -class: antimycobacterial (selective antituberculosis)-action: inhibits growth of mycobacteria by preventing synthesis of cell wall-use: active and latent tuberculosis-complications: peripheral neuropathy, hepatotoxicity, hyperglycemia, decreased glucose control-contraindications: liver disease-interactions: phenytoin (inhibits phenytoin metabolism); tyramine (aged cheese, cured meats); alcohol, rifamin, pyrazinamide (increase risk of hepatotoxicity)-nursing admin: take 1 hr before or 2 hrs after meals; complete entire course of therapy
Q: fluoxetine
Answer: -class: SSRI-action: allows more serotonin to stay at junction of neurons; takes up to 4 weeks to see results; produce CNS stimulation-use: panic disorder, OCD, PTSD-complications: sexual dysfunction; weight gain; GI bleeding; hyponatremia; serotonin disorder; bruxism; withdrawal; postural hypotension; suicidal ideation-contraindications: client taking MAOIs or a TCA; alcohol-interactions: MAOIs, TCAs, St. John’s Wort (increase serotonin syndrome); warfarin (increase warfarin levels); lithium and TCAs (do not take); NSAIDs and anticoagulants-nursing admin: take with food
Q: donepezil
Answer: -class: cholinesterase inhibitor (reversible inhibitor)-action: transmission of nerve impulses increased at all sites responding to ACh as a transmitter-use: treatment of Alzheimer’s and Parkinson’s-complications: excessive muscarinic stimulation (increased GI motility and secretions, diaophoresis, salivation, bradycardia, urinary urgency), cholinergic crisis (respiratory depression)-contraindications: pregnancy, obstruction of GI and renal system; cautious use for patients with seizure disorders, hyperthyroidism, peptic ulcer disease, asthma, bradycardia, hypotension-interactions: atropine, succinylcholine-nursing admin: dosage is very individualized, patients should wear medical alert bracelet
Q: tamoxifen
Answer: -class: hormonal agent: estrogen receptor blocker-action: stops growth of breast cancer cells, which are estrogen-dependent cancers-use: to treat and prevent breast cancer-complications: endometrial cancer, hypercalcemia, nausea and vomiting, pulmonary embolus, hot flashes, vaginal discharge or bleeding-contraindications: pregnancy class D, taking warfarin, history of blood clots or pulmonary embolism-interactions: increase anticoagulation action of warfarin, SSRI and antidepressants decrease effectiveness of tamoxifen-nursing admin: increase calcium and vitamin D intake, weight-bearing exercises, monitor for dysrhythmias, perform monthly breast exam
Q: diltiazem
Answer: -class: calcium channel blocker-action: block calcium channels in blood vessels leads to vasodilation of peripheral arterioles and arteries of heart; block calcium channels in myocardium, SA node, AV node leads to decreased force of contraction, decreased heart rate, slow rate of contraction-use: angina, hypertension, cardiac dysrhythmias-complications: orthostatic hypotension, peripheral edema, constipation, suppression of cardiac function, dysrhythmias, acute toxicity (AV block)-contraindications: older adults, kidney or liver disorders, GERD-interactions: beta blockers, grapefruit juice
Q: digoxin
Answer: -class: cardiac glycoside-action: positive inotropic effect (increased force of myocardial contraction), negative chronotropic effect (decreased heart rate)-use: second-line medication; treat heart failure, dysrhythmias; reduce manifestations but does not prolong life-complications: dysrhythmias, cardiotoxicity (monitor serum range 0.5-0.8, consume high-potassium foods to avoid hypokalemia, maintain potassium levels, monitor pulse), GI effects, CNS effects (diplopia, yellow-green/white halos, fatigue)-contraindications: patients with V-fib; cautious use with hypokalemia, partial AV block, advanced heart failure, impaired kidney function-interactions: thiazide diuretics, loop diuretics, ACE inhibitors, ARBs, dopamine, quinidine, verapamil, antacids-nursing admin: do not double missed dose; administer at same time daily; hold dose if pulse is <60
Q: fluticasone
Answer: -class: nasal glucocorticoid-action: decrease inflammation associated with allergic rhinitis; first line treatment for nasal congestion-use: reduce effects of allergic rhinitis including sneezing, nasal itching, runny nose-complications: sore throat, nosebleed, headache, burning in the nose-contraindications: administer dose daily not just when symptoms arise; can take 7 days for results; clear blocked nasal passages with topical decongestant before glucocorticoid
Q: methylprednisolone
Answer: -class: IV glucocorticoid-action: prevent inflammation, suppress airway mucus production, promote responsiveness of beta receptors in the bronchial tree; reduction in airway mucosa edema-use: short-term IV for status asthmaticus-complications: weight gain, round face, increased appetite-contraindications: clients who have diabetes mellitus, hypertension, heart failure, peptic ulcer disease, osteoporosis, kidney dysfunction-interactions: potassium-depleting diuretics, NSAIDs, glucocorticoids
Q: ergotamine
Answer: -class: migraine medication (ergot alkaloid)-action: prevent inflammation and dilation of intracranial blood vessels-use: abortive therapy to stop migraine after it begins-complications: GI discomfort, acute or chronic overdose, physical dependence, fetal harm or abortion-contraindications: renal or liver dysfunction, sepsis, hypertension, history of myocardial infarction, CAD; pregnancy risk category X-interactions: triptans, HIV protease inhibitors, antifungal medications, grapefruit juice-nursing admin: should not be used more than 2 days per week; avoid triggers; lie down in dark, quiet place; use antiemetics
Q: metoclopramide
Answer: -class: prokinetic agent-action: increase in upper GI motility which increases peristalsis-use: management of GERD-complications: extrapyramidal symptoms (restlessness, anxiety, spasms of the face and neck); sedation; diarrhea-contraindications: GI perforation, GI bleeding, bowel obstruction, hemorrhage, seizure disorder-interactions: alcohol and CNS depressants, opioids and anticholinergics-nursing admin: if IV dose is greater than 10 mg, it should be diluted and infused over 15 min
Q: ciprofloxacin
Answer: -class: fluoroquinolone (antibiotic)-action: bactericidal due to inhibition of an enzyme necessary for DNA replication-use: broad-spectrum antimicrobial; urinary, respiratory, GI, bones, joints, skin, soft tissue; prevents anthrax-complications: GI discomfort, achilles tendon rupture, suprainfection, phototoxicity-contraindications: not for children under 18, increases risk for c.diff, can affect CNS; cautious use for older adults or people with cardiovascular disorders-interactions: antacids, theophylline (plasma levels will increase), warfarin (plasma levels will increase)
Q: epoetin alfa
Answer: -class: erythropoietic growth factors-action: act on bone marrow to increase production of RBCs-use: anemia related to chronic kidney disease; anemia caused by chemo (nonmyeloid cancers); anemia caused by taking zidovudine for HIV/AIDS-complications: hypertension (increase in hematocrit), risk for thrombotic event, DVT, headache, body aches-contraindications: uncontrolled HTN, some cancers due to possible increase in tumor growth-nursing admin: monitor BP frequently; dosage is based on client’s weight; do not agitate the vile and only use for one dose; dosing is usually 3x/week; monitor iron levels; monitor Hgb and Hct 2x/week until target is reached
Q: haloperidol
Answer: -class: antipsychotic (first generation)-action: block dopamine, ach, histamine, NE; inhibit psychotic manifestations-use: psychotic disorders, schizophrenia, bipolar, Tourette, agitation-complications: acute dystonia, parkinsonism, akathisia, tardive dyskinesia, neuroleptic malignant syndrome, anticholinergic effects (dry mouth, blurred vision, photophobia, urinary retention, constipation, tachycardia), neuroendocrine effects, seizures, skin effects, orthostatic hypotension, sedation, sexual dysfunction, agranulocytosis, severe dysrhythmias, liver impairment-contraindications: client in a coma, severe depression, Parkinson disease, dementia; use cautiously for patients with glaucoma, paralytic ileus, prostate enlargement, heart disorders, liver or kidney disease, seizure-interactions: anticholinergic agents, CNS depressants, Levadopa-nursing admin: used for patients tolerating them well or for those who are very violent or agitated
Q: oxybutynin
Answer: -class: muscarinic antagonist-action: inhibit muscarinic receptors of the detrusor muscle of bladder which prevents contractions of the bladder and the urge to void-use: overactive bladder-complications: anticholinergic effects, CNS/cardiovascular efects-contraindications: glaucoma, myasthenia gravis, paralytic ileus, GI or GU obstruction, urinary retention; cautious use in children and elderly; cautious use w/ GERD, heart failure, or kidney or liver impairment-interactions: antihistamines, tricyclic depressants or phenothiazines can result in extreme muscarinic blockage
Q: amitriptyline
Answer: -class: tricyclic antidepressant-action: block reuptake of norepinephrine and serotonin which intensifies the effects of neurotransmitters-use: depression; depressive episodes of bipolar disorders; secondary uses: neuropathic pain, fibromyalgia, anxiety disorders, OCD, insomnia, ADHD-complications: orthostatic hypotension; anticholinergic effects (dry mouth, blurred vision, photophobia, urinary hesitancy or retention, constipation, tachycardia), sedation, toxicity, decreased seizure threshold, excessive sweating-contraindications: seizure disorders, recent MI; cautious use in elderly, CAD, diabetes, liver, kidney, respiratory disorders, urinary retention or obstruction, hyperthyroidism; patients at risk of suicide should receive only 1 week’s worth at a time due to lethality of overdose-interactions: MAOIs or St Johns Wort can lead to serotonin syndrome; antihistamines and anticholinergic have additive anticholinergic effects; increased effects of epinephrine and dopamine; TCAS decrease effect of ephedrine and amphetamine; CNS depressants-nursing admin: can take 10-14 days or longer to work and maximum effects 4-8 weeks
Q: gentamicin
Answer: -class: aminoglycoside-action: bactericidal antibiotics that disrupt protein synthesis-use: aerobic gram-negative bacilli-complications: ototoxicity; nephrotoxicity; intense neuromuscular blockade; hypersensitivity-contraindications: cautious use w/ kidney impairment, hearing loss, myasthenia gravis; cautious use for those taking ethacrynic acid, amphotericin B, cephalosporins, vancomycin, neuromuscular blocking agents; kidney impairment-interactions: penicillin inactivates gentamicin when in same IV solution; loop diuretics increase risk of ototoxicity-nurse admin: parenteral; dosing schedule (peak 30 min after admin)
Q: hydrocodone/acetaminophen
Answer: -class: Analgesic, Opioid/Acetaminophen Combination-action: acts on CNS to relieve pain-use: relieve moderate to moderately severe pain-complications: respiratory depression, overdose, dependency-contraindications: allergic reaction to acetaminophen, hydrocodone, or other narcotic medicines; stomach or bowel blockage
Q: rantidine
Answer: -class: histamine2 receptor antagonist-action: block H2 receptors, which reduces the volume of gastric acid and lowers concentration of hydrogen ions in the stomach-use: gastric and duodenal ulcers, GERD, hypersecretory conditions, aspiration pneumonitis, heartburn, acid indigestion; conjunction w/ antibiotics to treat ulcers caused by H.Pylori-complications: constipation, diarrhea, nausea-contraindications: use in older adults can cause impotence and CNS effects (confusion); decrease gastric acidity; cautious use w/ high risk of pneumonia (COPD)-interactions: climetidine, antacids
Q: furosemide
Answer: -class: high-ceiling loop diuretic-action: block reabsorption of sodium and chloride and prevents reabsorption of water; extensive diuresis even with renal impairment-use: emergent need for rapid mobilization of fluid (pulmonary edema)-complications: dehydration, hyponatremia, hypochloremia, hypotension, ototoxicity, hypokalemia, decrease HDL levels, increase LDL levels, hyperglycemia,-contraindications: pregnancy, anuria, cardiovascular disease, diabetes mellitus, dehydration, gout, electrolyte depletion-interactions: digoxin, antihypertensives, lithium, NSAIDs
Q: allopurinol
Answer: -class: antigout medication (agent for hyperuricemia)-action: inhibit uric acid production-use: hyperuricemia due to chronic gout or secondary to chemo-complications: hypersensitivity reaction, fever, rash, kidney, liver damage, kidney injury, hepatitis, increase in gout attacks-contraindications: medication hypersensitivity or idiopathic hemochromatosis; rhabdomyolysis is most likely w/ long-term use and risk is higher in patients using statins-interactions: slows metabolism of warfarin
Q: nitroglycerin
Answer: -class: nitrate-action: dilates veins and decreases venous return (preload) which decreases cardiac oxygen demand; variant angina it prevents or reduces coronary artery spasm which increases oxygen supply-use: treatment of acute angina attack-complications: headache, orthostatic hypotension, reflex tachycardia, tolerance-contraindications: severe anemia, glaucoma, TBI b/c it increases intracranial pressure; cautious use for people taking HTN medications and people w/ hyperthyroidism or kidney or liver dysfunction-interactions: alcohol, antihypertensive meds, nitroglycerin can result in life-threatening hypotension
Q: sucralfate
Answer: -class: mucosal protectant-action: acidic environment changes sucralfate into a protective barrier that adheres to an ulcer which protects ulcer from further injury from acid and pepsin; viscous substance can stick to ulcer for up to 6 hrs-use: acute duodenal ulcers and those requiring maintenance therapy; not absorbed so no systemic effects-complications: constipation-contraindications: chronic kidney disease-interactions: sucralfate interferes w/ absorption of phenytoin, digoxin, warfarin, cipro; antacids interfere w/ absorption of sucralfate
Q: metoprolol
Answer: -class: beta blocker (cardioselective)-action: blockade in the myocardium and in electrical conduction of the heart; decreased heard rate; decreased myocardial contractility decreases cardiac output-use: primary HTN, angina, tachydysrhythmias, heart failure, myocardial infarction, suppresses reflex tachycardia-complications: bradycardia, decreased cardiac output, AV block, orthostatic hypotension, rebound myocardium excitation-contraindications: AV block and sinus bradycardia; myasthenia gravis, hypotension, peripheral vascular disease, diabetes mellitus, depression, older adults and those who have severe allergie-interactions: calcium channel blockers intensify effects of beta blockers; antihypertensive meds and beta blockers can intensify hypotensive effect of both meds
Q: captoprillisonoprilenalapril
Answer: -class: ACE inhibitor-action: reduce production of angiotensin II resulting in vasodilation, excretion of sodium and water and retention of potassium, reduction of changes in heart and vessels that result from presence of angiotension II and aldosterone-use: hypertension, heart failure, MI, nephropathy, for those at risk for cardiovascular event-complications: first-dose orthostatic hypotension, cough, hyperkalemia, rash and altered taste (mostly with captopril), angioedema, neutropenia (msotly with captopril)-contraindications: pregnancy, allergy to ACE inhibitors, bilaterial renal stenosis, one kidney; cautious use in patients with kidney impairment and collagen vascular disease-interactions: diuretics, antihypertensives, potassium supplements and potassium sparing diuretics, lithium, NSAIDs-nursing admin: take captopril at least 1 hr before meals, rise slowly from sitting
Q: docusate sodium
Answer: -class: surfactant laxative-action: lower surface tension of stool to allow penetration of water-use: relieve constipation; prevent painful elimination in patients w/ hemorrhoids; prevents straining in patients in which it is contraindicated; decrease risk of fecal impaction in immobile patients and promote defecation in older adults-complications: sodium absorption and fluid retention, GI irritation-contraindications: fecal impaction, bowel obstruction, acute surgical abdomen, ulcerative colitis-nursing admin: instruct patient to increase high-fiber foods, and to increase amounts of fluids (2-3 L/day); take with 8 oz of water
Q: bupropion
Answer: -class: atypical antidepressant (norepinephrine-dopamine reuptake inhibitor)-action: inhibiting norepinephrine and dopamine uptake-use: treatment of depression; alternative to SSRIs and SNRIs for patients unable to tolerate sexual dysfunction side effects; aid for smoking cessation; prevention of seasonal pattern depression; alternative treatment of ADHD-complications: headache, dry mouth, GI distress, constipation, increased heart rate, HTN, restlessness, insomnia, nausea, vomiting, anorexia, weight loss, seizures-contraindications: MAOIs, patients with seizures or eating disorders-interactions: MAOIs increase risk of toxicity
Q: dantrolene
Answer: -class: peripherally acting muscle relaxant-action: acts directly on spastic muscles and inhibits muscle contraction by preventing release of calcium in skeletal muscles-use: relief of spasticity related to cerebral palsy, spinal cord injury, and multiple sclerosis; treatment of malignant hyperthermia-complications: CNS depression, hepatic toxicity (anorexia, nausea, vomiting, abdominal pain, jaundice), muscle weakness-contraindications: pregnancy class C-interactions: CNS depressants-nursing admin: do not stop taking abruptly
Q: atorvastatin
Answer: -class: HMG-CoA reductase inhibitors (statins)-action: decrease manufacture of LDL and VLDL; increase manufacture of HDL; promotion of vasodilation, decrease in plaque site inflammation, thromboembolism, and risk of A-fib-use: primary hypercholesterolemia; prevention of coronary events; protection against MI and stroke for patients with diabetes mellitus; increasing levels of HDL; prevention in clients w/ normal LDL-complications: hepatotoxicity, myopathy-contraindications: pregnancy category X, liver disorder or breast feeding-interactions: fibrates increase risk of myopathy, grapefruit juice increases levels of statin
Q: propylthiouracil
Answer: -class: thionamides-action: block synthesis of thyroid hormones; prevents oxidation of iodide; blockers conversion of T4 into T3-use: treatment of Graves’ disease; produces euthyroid state prior to thyroid removal surgery; adjunct to irradiation of thyroid gland; emergency treatment in thyrotoxicosis-complications: hypothyroidism, agranulocytosis (sore throat, fever, fatigue), liver injury/hepatitis-contraindications: Pregnancy Category D and lactation; cause use in patients with bone marrow depression/immunosuppression, and those at risk for liver failure-interactions: antithyroid meds and anticoagulants can increase anticoagulation; digoxin can increase glycoside level-nursing admin: therapeutic effect can take 1-2 weeks to begin and can take 3-12 months for full benefit; take at consistent times during the day with meals; may be given propranolol to decrease tremors and tachycardia; avoid consumption of seafood