A. There are risks associated wit the drugs: since there is nobody to advise you on the medication to take based on your condition, misdiagnosis can occur leading to the selection of a wrong drug. OTC drugs have adverse side effects. The description on the label are usually vague: a person can easily under of overdose themselves. (Karch, et al. 12).
B. Generic and brand name drugs have the same active ingredients the difference however arises in the inactive ingredients which tend to be different; this is however critical in rare cases for instance when a patient is sensitive or allergic to one of the excipients (Karch, et al. 12).
Chapter 2.
A. The interaction of drugs in the body can increase or decrease the effectiveness of a drug in a person; this can result to toxicity or drug failure.
B. pharmacodynamic is a process by which a drug interacts or works in a body. Drugs can work by depressing or stimulating cellular activity, replacing the chemical of a missing body or through interfering a body’s enzyme systems (Karch, et al. 20). Pharmacokinetics is the study of the movement of drugs within the body. The balance of adsorption, distribution, metabolism and excretion of a drug is used to determine the concentration of a drug in a body.
C. The nurse should ask the patient whether they have any known drug allergy. Patients should also be asked if they are on any medication and if so what type (Karch, et al. 29).
D. The amount of medication that will remain 4 hours after the administration of medication will be 10mg.
Chapter 6
A In terms of navigation, is the site easy to access, navigate of confusing? The individual that prepared the website, the person who maintains it and their qualifications? Is feedback and interaction possible on the website? How frequent is the data updated? If the information provided on the website is supported by websites? How accurate the information is with other sources? (Karch, et al. 66).
B The nurse should ask specific questions concerning the use of over the counter drugs and medications because OTC medications are able to mask the signs and symptoms of an illness, they interact with prescription drugs and a person can overdose on them leading to toxicity (Karch, et al. 66). Herbal therapies can produce toxic reactions and unexpected effects they can also interact with prescription drugs can contain ingredients that are unknown altering their toxicity and effectiveness (Karch, et al. 67).
C. The uses are widespread and, in some cases, lead to the discovery of new uses of drugs. Using a drug for a different indication might eventually lead to the approval of the new indications (Karch, et al. 68).
Chapter 9
To determine the antibiotic that is selected for a clinical situation, the causative organism is identified through a culture. Sensitivity testing is also carried out to determine the antibiotic that best controls or kills the bacteria (Karch, et al. 98)
A Common adverse effect include dizziness, headaches, nausea, vomiting, electrolyte imbalances, dehydration and an altered mental state. Cases of seizures have been reported when the antibiotic is combined with other drugs (Karch, et al. 98).
B Specific points that the student nurse should include in patient teaching for ertapenem, cefaclor and ciprofloxacin are taking safety precautions such as slowly changing positions and avoiding hazards tasks and driving if CNS effects occur. Even though vomiting, nausea diarrhea might occur the patient should maintain nutrition and drink a lot of fluids. (Karch, et al. 106, 110,113). Specific teachings for cefaclor include avoiding alcoholic drinks while receiving the antibiotic for at least 72 hours after completing the course of the drug since serious side effects can occur (Karch, et al. 110). For ciprofloxacin, the patient should try to avoid sun exposure and ultra violet light using sunscreens and protective clothing. (Karch, et al. 113).
Chapter 10
A A single virus particle is made up of a piece of RNA or DNA inside a protein coat. For a virus to carry out metabolic activities such as replication it needs to enter a cell. (Karch, et al. 138).
The common adverse effects of zidovudine related to the Gastrointestinal tract include dyspepsia, dry mouth, abdominal pain, nausea, constipation or diarrhea. Cases of headache, blurred vision and dizziness have also been reported (Karch, et al. 149).
B A known history to allergic reactions to antivirals to prevent hypersensitivity reactions. It also includes the history of renal or liver dysfunction which might interfere with metabolism and excretion and current status related to lactation or pregnancy to prevent adverse effects on the baby that is being nursed or the fetus (Karch, et al. 149)
Chapter 12
A Malaria is caused by four protozoal parasites in the genus Plasmodium. These parasites spend part of their time in an anopheles mosquito and a human host. When a mosquito bites a person infected with malaria it sucks blood containing the female and male forms of plasmodium referred to as gametocytes. These forms, mate inside the mosquito’s stomach, producing a zygote which goes through various phases before they form sporozoites that travel to the salivary gland of the mosquito. Thousand of sporozoites are injected to the next person that the mosquito bites. These sporozoites travel through the blood stream and lodge themselves on the human liver and other tissues invading the cells. While inside the cell of a human being, the organism go through reproduction and asexual cell division. Over the next 7 to 10 days, schizonts, the primary tissue organisms grow and multiply within the cells they have invaded using the cell for the nutrients that they require.
From the primary schizonts, merozoites are formed bursting from the cells that they had invaded due to over expansion (Karch, et al. 179). The red blood cells are invaded after the merozoites enter the blood circulation. While in the red blood cells, they continue to replicate until the cells burst increasing the number of merozoites in the circulation to seize yet other red blood cells. In due course the number of merozoites in the body increases greatly together with the number of invaded and raptured red blood cells ( Leffler, et al. 356) Rupturing of the red blood cells leads to fever and chills associated to the protozoa’s pyrogenic effects and the toxic effects of the components of the red blood in the body. The cycle of fever and chills occurs in about every 72 hours (Karch, et al. 180).
B The goal for treatment of malaria is complete cure. It is carried out to prevent the progression of the disease to a severe illness or death.
C The common adverse reactions of drugs used to treat malaria include: Central Nervous system effects such as dizziness and headaches. Immune reaction effects associated with the release of merozoites include malaise, fever, chills and shaking. Effects of the drugs on the GI tract include anorexia, nausea, dyspepsia and vomiting. Toxic effects of the drugs include hepatic dysfunction on the liver (Karch, et al. 183).
D Other common protozoal infections that the patient can develop include Amebiasis which is an infection that affects the intestines and is caused by Entamoeba histolytica also referred to as amebic dysentery. The patient can also develop Leishmaniasis, an illness caused by a protozoan transmitted from sand flies to human beings. The sand fly injects amastigotes into the body of a person which cause lesions in the mucous membrane, skin or the viscera of the host. The person can also be infected by Trypanosoma which causes trypanosomiasis. Tsetse flies can transmit trypanosoma brucei gambiense causing African sleeping sickness. Trypanosoma cruzi on the other hand causes chaga’s disease that is transmitted to human beings by a common housefly. It causes severe cardio-myopathy. Trichomoniasis is also another protozoan disease caused by trichomonas vaginalis which causes vaginitis. In females, it causes a reddened inflamed vaginal mucous, burning, itching and a yellowish green discharge. The person can also be affected by Giardiasis which is caused by Giardia Lamblia. Patients experience diarrhea a pale and mucus filled stool and a rotten egg-smelling stool.
Key nursing considerations for patients receiving antiprotozoal agents include assessing for cautions and contradictions, performing a physical assessment to determine baseline information for the drugs effectiveness and the occurrence of any effects linked with the drug. Evaluating the central nervous system to check for muscle strength and reflexes. Examining the mucous and skin membrane to check for color, texture, temperature and lesions.
Chapter 16
A Common adverse reactions for patients receiving for nonsteroidal anti-inflammatory agents include nausea, flatulence, GI pain, diarrhea, dyspepsia and constipation that are caused by direct effects of the drug to the GI. Fatigue, headache, somnolence and dizziness are also other reactions. (Karch, et al. 267).
B Key considerations in using anti-inflammatory agents in older adults include cautioning adults about the presence of the drugs in a lot of over the counter products and teaching them to be aware of the specific things that they are taking to avoid toxic effects. The drugs should not be used by pregnant and lactating women unless the benefits outweigh potential risks to the neonate of fetus (Karch, et al. 258).
C Assessing the cautions of contraindications. Determining the presence of any skin lesions to evaluate dermatological effects. Patient teaching includes providing measures to prevent adverse effects and the warning signs of the problems. Patients should also be taught on measures of proper administration (Karch, et al. 258).
Chapter 20
A States affected by anxiolytic and hypnotic agents include anxiety which is a feeling of apprehension, tension, nervousness of fear involving unpleasant reactions to an actual or unknown stimulus (Karch, et al. 325). Sedation is condition in which a person loses a sense of awareness as well as the reaction to any environmental stimuli (Karch, et al. 325). Heavily sedating a person results in CNS sleep depression or hypnosis (Karch, et al. 326).
B For a patient receiving benzodiazepine nursing implementation considerations include not administering intra-arterially since serious gangrene and arteriospasm can occur. To avoid any drug to drug interactions, the nurse is not required to mix other drugs with intravenous (IV) drugs in solution form (Karch, et al. 330). Patient teaching should also be provided such as the name of drug, the dose that is prescribed and measures of avoiding adverse effects among others.
C The nurse should teach the students that zaleplon is an oral drug that treats insomnia for a short term. Students should also use it with caution in patients that have renal or hepatic impairment. The drugs are also very sensitive in old patients. For zolpidem, students should learn that to a suicidal or depressed patient, the least amount possible of the drug should be dispensed.
Chapter 23
A Patients should be taught about old stigmas, how people can react to their diagnosis. They should be taught ways in which they can educate friends and family members about the condition and its treatment (Karch, et al. 377).
B Phenytoin directly stabilizes nerve membranes in the whole central nervous system through influencing the cell membranes ionic channels and as a result minimizing excitability and hyper-excitability to stimulation (Karch, et al. 380).
C Cancelling the drug at any sigN of liver dysfunction, hypersensitivity reaction or a severe skin rash. The drug should be administered with food (Karch, et al. 389)
Chapter 26
A The gate control theory of pain states that non-painful inputs close the nerve also referred to as gates to the painful input that prevents the sensation of pain from travelling to the central nervous system. The theory asserts that within the spinal cord, there is neurological gate which either blocks or allows pain signals to continue to the brain. Signals of pain that are travelling through small nerve fibers are permitted to go through while those sent by large nerve fibers are blocked (Karch, et al. 425)
B Older adults should always be asked if they require pain medication. The adverse effects of these drugs are more likely to be experienced by older patients including cardiovascular, gastrointestinal, and central nervous system effects.
C Performing periodic and baseline pain assessments to monitor the effectiveness of the drug and offer the right changes as required in the pain management protocol. (Karch, et al. 435).
D Before the use of any antimigraine drug adults seeking treatment for migraine headaches should be monitored carefully to ensure that they type of migraine being treated can benefit from the drugs being administered.
Chapter 30
A Therapeutic actions for isoproterenol are associated to the stimulation of beta-adrenergic receptors. The drugs desired effects include an increased contractility, heart rate, and conductivity. Increased flow of splanchnic beds and skeletal muscles.
B Adverse effects of an isoproterenol on the CNS include anxiety, restlessness, headache, fatigue tremor and fear. CV effects include palpitations, tachycardia, myocardial infarction, and angina.
C Adverse effects include angina, palpitations, hypertension and arrhythmias. Constipation, vomiting and nausea are also associated with the effects. Other effects include anxiety, tension, sweating and headache (Karch, et al. 490).
D Using extreme caution in preparing and calculating doses of the drugs. When administering nasal or ophthalmic agents, proper aseptic techniques should be used.
Chapter 36
A Administering the drug 8 to 9 am daily. Using the minimal dose for the minimal amount of time and using alternate day maintenance therapy with drugs that are short acting.
C Common adverse reactions for fludrocortisone include vertigo, headache, psychosis, insomnia and convulsions.
D Indications for predinosine include the short-term management of a lot of allergic and inflammatory disorders, in adrenal cortical insuffiency, replacement therapy should be used, multiple sclerosis of acute exacerbations, in some leukemias palliation.
Chapter 38
A Thickening of the basement membrane, in small and large blood vessels. The thickening causes changes vessel’s lining oxygenation, damaging the lining which causes narrowing, the vessel is also remodeled, with the blood flow decreasing.
B Ensuring that patients follow an exercise and dietary regimen while using proper hygiene practices. The selected site should be free from scarring and bruising.
C Chlorpropamide indicated as an adjunct to exercise and diet for blood glucose to be lowered in diabetes mellitus.
D Vomiting, nausea, anorexia, and heartburn. Allergic skin reactions have also been reported.
F Lifespan considerations for children using antidiabetic agents include monitoring children of any signs of hyperglycemia and treating them quickly. In teenagers, a team approach is the best way to assist children in dealing with the disease.
Chapter 42
A The cardiac cycle involves the performance of the heart of a human being from the start of one heartbeat to the other.
B The hearts conduction system is made up of a group cells from the cardiac muscle that are found in the wall of the heart sending signals to heart muscles and causing it to contract. The conduction system’s vital components include the bundle of his, AV node, bundles branches SA node and Purkinje fibers (Karch, et al. 690).
C The normal ECG pattern is composed of five main waves: The P wave that is formed as impulses which originate in the SA node of the pacemaker passing through the atrial tissues; the QRS representing his bundle depolarization (Q) as well as the ventricles (RS); The T wave representing the ventricle’s repolarization (Karch, et al. 691)
The four normal control of blood pressure include sympathetic system stimulus, blood volume reflex control, pressure by the renin-angiotensin system and the ADH system (Karch, et al. 698).
D Capillary fluid shift is when fluid shift blood at the capillaries arterial ends to deliver nutrients and oxygen to the tissues. The movement of the fluid is influenced by fluid or hydrostatic pressure of the systems arterial side and the oncotic pull of proteins which causes the fluid to return to the system at the capillaries venous end.
Chapter 43
A Captopril is indicated for the treatment of hypertension singularly or when combined with other drugs.
B Diltiazem acts in the lungs in preventing ACE from converting angiotensin I to angiotensin II; this leads to a decrease in blood pressure, a loss of sodium, serum and fluid and a slight increase in serum potassium.
C Reflex tachycardia, heart failure angina and chest pain. GI effects include liver injury, constipation, ulcers and irritation.
D Older adults are more vulnerable to the drugs toxic effects and are likely to have underlying conditions which can interfere with drug excretion and metabolism.
E. Nursing implementation condition include encouraging patients to follow the lifestyle changes and administering the drug on an empty stomach and 1 1 hour before of 2 hours after meals
Chapter 45
A Therapeutic action for lidocaine and propanolol includes stabilizing the cell membrane by binding to sodium channels. They bind quickly to sodium channels which are interactive or open.
B Diltiazem is indicated for treatment of ventricular arrythmias that is life threatening. Due to the risk of a proarrhythmic effect, it should not be used in treating other arrythmias. In terms of Pharmacokinetics, the drugs are well distributed after rapid absorption through the GI tract or after injection (Karch, et al. 751).
B Older adults are likely to develop adverse effects linked to the use of this drug such as congestive heart failure, hypotension and arrhythmias.
C Titrating the dose to the least possible amount that is required to control arrhythmia. When changing or initiating the dose, the cardiac rhythm should be monitored continually (Karch, et al. 757).
Chapter 48
A Therapeutic action for aspirin heparin and urokinase includes inhibiting platelet aggregation and adhesion through blocking receptor sites on the membrane of the platelet, preventing the interaction of platelet to platelet, of the interaction of clotting chemicals with platelets. The most common adverse reactions with the drugs include bleeding, which occurs as increased bleeding and bruising while the person is brushing teeth.
B Antihemophilic factors are contraindicated to mouse proteins in the presence of a known allergy. During pregnancy, they should only be used if the benefit to the mother outweighs any risk to the fetus. In terms of pharmacokinetics, these drugs substitute normal clotting factors and are processed by the body in that manner. They should be administered intravenously and processed by the body in a similar manner to natural occurring clotting factors.
C. The correct clotting factor should be used for the patient, clotting factors and clinical response levels should be monitored. (Karch, et al. 819).
Chapter 51
A Chloride pumps are blocked by diuretics. To maintain electrical neutrality, sodium and chloride move passively. Common adverse effects include the upset of the GI, electrolyte and fluid imbalance, electrolyte imbalances, and hypotension.
B Diuretics are contraindicated for use in patients with allergy. They should only be used in situation where the benefits that the mother receives are greater than the risk to the fetus.
C Patients should be taught that Lasix assists in reducing the amount of fluid in the body of a person.
D In children diuretics are used to edema which is linked to heart defects. Adults taking diuretics are required to weigh themselves daily to monitor sudden fluid loss or retention. Older adults should be administered the lowest possible dose to begin with. (Karch, et al. 859).
Chapter 57,
A It is currently believed that chronic cancer is as a result of Helicobacter pylori bacteria
B H2 receptors are selectively blocked by H2 antagonists that are found on the parietal cells. When these receptors are blocked, gastrin is not released which ends up blocking the production of hydrochloric acid.
C Acid rebound happens when the stomach produces more gastrin and acid in response to lower acid levels in the stomach, happens when antacids are used often.
D H2 antagonists should not be used when a person is allergic to any drug
F. The drug reduces the amount of acid produced in the stomach.
References
Karch, Amy Morrison, and Karch. Focus on nursing pharmacology. Lippincott Williams " Wilkins, 2003.
Leffler, Ellen M., et al. "Resistance to malaria through structural variation of red blood cell invasion receptors." Science 356.6343 (2017): eaam6393.
