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NRSG 3440 FINAL EXAM ASSESSMENT UPDATED
QUESTIONS & COMPLETE SOLUTIONS A+ GRADED
Tylenol (Acetaminophen) - ANSWER>>>>>>>FIRST CHOICE for mild pain Avoid in hepatic issues. BenGray, Arthricare, IcyHot - ANSWER>>>>>>>OTC creams used for mild pain. Avoid heating pads over cream. Aspercreme - ANSWER>>>>>>>Topical salicylate used for mild pain. Assess for aspirin allergy. Capsaicin Cream (Zostrix) - ANSWER>>>>>>>Topical agent for pain made from peppers that helps with nerve pain. Ibuprofen (Motrin) - ANSWER>>>>>>>NSAID used for moderate pain that can go up to 2400 mg/day.` Mobic (Meloxicam) - ANSWER>>>>>>>NSAID for moderate pain taken once a day Diclofenac Gel - ANSWER>>>>>>>Topical NSAID with lower risks of GI side effects than other NSAIDs. Toradol (Ketorolac) - ANSWER>>>>>>>NSAID that is most commonly used in acute care settings. Burns when given IM or IV, so must be given in a large muscle. BUN, Creatinine, I&Os - ANSWER>>>>>>>Things we must monitor when administering NSAIDs
Misoprostol (Cytotec) - ANSWER>>>>>>>Given with NSAIDs to reduce GI side effects, but is abortive & stimulates contractions. Must wear gloves! Arthrotec - ANSWER>>>>>>>A combination of misoprostol & NSAIDs Celebrex (Celecoxib) - ANSWER>>>>>>>COX-2 Inhibitor NSAID that has higher risk of GI side effects. Fentanyl Patch - ANSWER>>>>>>>Narcotic agent that must be changed every 72 hours & discarded carefully. Cyclobenzaprine (Flexeril) Metaxalone (Skelaxin) Tizanidine (Zanaflex) ANSWER>>>>>>>Muscle relaxants used for pain Cause drowsiness Addiction potential Gabapentin (Neurontin) - ANSWER>>>>>>>Anticonvulsant used for radiculopathy & nerve pain. Risk for addiction (controlled substance). Elavil (amitriptyline) - ANSWER>>>>>>>TCA antidepressant that treats chronic pain & diarrhea with anticholinergic effects Duloxetine (Cymbalta) - ANSWER>>>>>>>SSRI used for pain Causes sedation & constipation Corticosteroids - ANSWER>>>>>>>Used for moderate pain control & decreasing
Hydroxychloroquine (Plaquenil) - ANSWER>>>>>>>DMARD for rheumatoid arthritis Originally a drug for malaria. May cause blindness, so obtain baseline eye exam & reevaluate once a year. Biphosphonates - ANSWER>>>>>>>Used for osteoporosis, osteopenia, & Paget Slows bone absorption Sit up for 1 hour after administration Fosamax - ANSWER>>>>>>>Biphosphonate given daily or weekly Boniva - ANSWER>>>>>>>Bisphosphonate given monthly or quarterly (4x a year) Esophagitis & GI ulcers Risk of DVT - ANSWER>>>>>>>Side effects of bisphosphonates Prolia (Denosumab) - ANSWER>>>>>>>Monoclonal antibody medication for osteoporosis, osteopenia, Paget's Binds to receptors that feed osteoclasts Given SQ 2x a year Calcitonin - ANSWER>>>>>>>Used for osteoporosis by pulling calcium out of bone & putting it back into the bone. Watch for nausea, rash, hypocalcemia. Calcium supplements - ANSWER>>>>>>>Avoid taking with vitamin C (ascorbid acid) Tumor Necrosis Factor (TNF) Inhibitors - ANSWER>>>>>>>Most common type of BRMS that stops inflammatory process Increases risk of TB or other infections Avoid live vaccines Monitor for bleeding Do not give in cancer, heart disease, or M.S. patients -
ANSWER>>>>>>>Considerations for TNF inhibitors (BRMS) Azathioprine (Imuran) - ANSWER>>>>>>>BRMS given for Crohn's or Ulcerative Taken orally once or twice daily on an EMPTY stomach Take 1 hr before or 3hrs after food or milk Adalimumab (Humira) - ANSWER>>>>>>>BRMS given for Crohn's or Ulcerative SQ injection taken every week or every other week Etanercept (Enebrel) - ANSWER>>>>>>>BRMS given for Crohn's or Ulcerative SQ injection taken weekly Ustekinumab (Stelera) - ANSWER>>>>>>>BRMS given for Crohn's or Ulcerative SQ injection every 3 months Infliximab (Remicade) - ANSWER>>>>>>>BRMS given for Crohn's or Ulcerative IV infusion q 8 weeks after 3 starter doses May develop sudden allergy Tums (Ca++ Carbonate) Mylanta Milk of Magnesia (Mg+ hydroxyzine) Maalox - ANSWER>>>>>>>Antacids Neutralize stomach acid Do not take with food Increased risk of C.diff Pepcid (famotidine) & Zantac (ranitidine) - ANSWER>>>>>>>H2 blockers used to decrease gastric acid Take 30-90 mins before meal Risk of heart rhythm issues in patients with renal issues Increased risk of C.diff Reglan (Metoclopramide) - ANSWER>>>>>>>Prokinetic & laxative Accelerates gastric emptying May cause tardive dyskinesia (reduce with benadryl)
Vitamin K - ANSWER>>>>>>>Given for acute GI bleed Promotes clotting factors from liver Imodium (Loperamide) - ANSWER>>>>>>>Antidiarrheal used sparingly Give 1 tab per loose stool Lomotil (diphenoxylate atropine) - ANSWER>>>>>>>Antidiarrheal used sparingly (has atropine & narcotics) Contraindicated in the elderly, risk for falls Metamucil (Psyllium) - ANSWER>>>>>>>Bulk-forming laxative & antidiarrheal Miralax (polyethylene glycol) - ANSWER>>>>>>>Laxative taken once daily mixed with liquid Linzess (linaclotide) - ANSWER>>>>>>>Laxative that increases fluid in intestines Speeds movement of food in the gut Lactulose (cephulac) - ANSWER>>>>>>>Hepatic encephalopathy treatment Causes excretion of ammonia in feces Titrate to 2-3 soft BMs a day Sweet tasting Given PO or retention enema Potassium Chloride - ANSWER>>>>>>>Hepatic encephalopathy treatment Replaces low electrolyte levels when medication-induced diarrhea begins Flagyl (metronidazole) - ANSWER>>>>>>>Antibiotic used in the short-term to decrease ammonia-forming gut bacteria AVOID ALL FORMS OF ALCOHOL Xifaxan (Rifaxamin) - ANSWER>>>>>>>Antibiotic used in the short-term to decrease ammonia-forming gut bacteria Kills E.coli & works on IBS-D
N-acetylcysteine (Mucomyst) - ANSWER>>>>>>>Vasodilator Antidote for Tylenol Given PO, IV, nebulized Smells like rotten eggs Penicillin - ANSWER>>>>>>>Antidote for mushrooms Pancrease - ANSWER>>>>>>>Pancreatic enzyme replacement combination of amylase, trypsin, & lipase Take with MEALS Steatorrhea if not taken Ursodeoxycholic acid (Actigall, Urso) - ANSWER>>>>>>>Treats cholelithasis by dissolving current stones & preventing new ones from forming Prevents biliary cirrhosis Watch for BACK PAIN Chenodiol (Chenix) - ANSWER>>>>>>>Treats cholelithasis by reducing biliary cholesterol Separate from cholesterol medications by at least 4 hours Watch for DIARRHEA methyl tertiary butyl ether (MTBE) - ANSWER>>>>>>>Treats cholelithasis by dissolving stones RARELY used Used to make gasoline (YIKES!) Meperidine (Demerol) - ANSWER>>>>>>>Treats cholelithasis as preferred pain medication instead of morphine Morphine - ANSWER>>>>>>>Causes pain & contracture of biliary sphincter in order to promote visualization on HIDA scan
