Pharmacology Quiz 2 NU 160

Correct Answer A: Salmeterol is often used in combination with an inhaled corticosteroid.

Explanation of the Correct Answer:

A. Salmeterol is often used in combination with an inhaled corticosteroid.

Salmeterol is a long-acting beta-2 agonist (LABA) used in the management of asthma and chronic obstructive pulmonary disease (COPD). It is often combined with inhaled corticosteroids (ICS) such as fluticasone to control inflammation and prevent bronchoconstriction in patients with asthma or COPD. The corticosteroid reduces inflammation, while salmeterol helps to keep the airways open. This combination enhances the overall effectiveness of treatment.

Why the Other Options Are Incorrect:

B. Salmeterol is primarily used to treat bacterial infections.

This statement is incorrect. Salmeterol is not used to treat infections. It is a bronchodilator used to manage asthma and COPD symptoms by relaxing the muscles of the airways. It does not have any antibacterial properties.

C. Salmeterol is used for immediate relief of acute asthma symptoms.

This is incorrect. Salmeterol is a long-acting beta-2 agonist (LABA), meaning it works over a long duration (12 hours or more), but it does not provide immediate relief. Short-acting beta-2 agonists (SABAs) like albuterol are used for acute relief because they work quickly to relax the airway muscles. Salmeterol is not meant for immediate symptom relief in an asthma attack.

D. Salmeterol is a short-acting beta-2 agonist.

This is also incorrect. Salmeterol is a long-acting beta-2 agonist (LABA), not a short-acting one. Short-acting beta-2 agonists (SABAs) have a rapid onset of action and are used for quick relief, while LABAs, such as salmeterol, are used for long-term control and prevention of asthma and COPD symptoms.

Summary:

The correct answer is A because salmeterol is often used in combination with an inhaled corticosteroid to help control asthma and COPD symptoms. It is not used to treat bacterial infections, provide immediate relief, or as a short-acting agent.

Correct Answer D: Constipation

Explanation of the Correct Answer:

Mydriatic eye drops, which are often used to dilate the pupils, contain medications that can have anticholinergic effects on the body. These effects occur because the drug blocks acetylcholine, a neurotransmitter involved in the parasympathetic nervous system. Common systemic anticholinergic effects include dry mouth, blurred vision, urinary retention, and constipation. Constipation is a hallmark of anticholinergic toxicity due to reduced intestinal motility. If the client shows signs of constipation, it should be reported, as this could indicate an excessive systemic absorption of the drug.

Why the Other Options Are Incorrect:

A. Seizures:

Seizures are not a common systemic effect of anticholinergic medications like mydriatic drops. While severe toxicity could cause CNS symptoms, seizures are typically not the first sign.

B. Bradycardia:

Bradycardia (slow heart rate) is generally associated with cholinergic effects, which stimulate the parasympathetic nervous system. Mydriatic eye drops cause anticholinergic effects, which typically result in tachycardia (increased heart rate), not bradycardia.

C. Hypothermia:

Hypothermia is not typically a result of anticholinergic effects. Anticholinergic drugs might cause fever (hyperthermia) due to impaired sweating and thermoregulation, not hypothermia.

Summary:

The manifestation that indicates a systemic anticholinergic effect from mydriatic eye drops is constipation, as these medications can slow down gastrointestinal motility. If the client exhibits this symptom, the nurse should monitor for potential anticholinergic toxicity.

Correct Answer B: Inspect your mouth for lesions daily.

Explanation of the Correct Answer:

Fluticasone is an inhaled corticosteroid (ICS) used for the long-term control of chronic obstructive pulmonary disease (COPD) and asthma. It helps reduce inflammation in the airways, making breathing easier over time.

One of the potential side effects of inhaled corticosteroids like fluticasone is the development of oral thrush, which is a fungal infection that can cause lesions in the mouth. It is important for the client to inspect their mouth daily for any signs of white patches, sores, or irritation. If these symptoms occur, the client should report them to their healthcare provider, as they may need treatment with antifungal medication. Rinsing the mouth with water after using the inhaler can help prevent this side effect.

Why the Other Options Are Incorrect:

A. Skip the morning dose if you do not have any symptoms. 

This is not a recommended instruction. Fluticasone is a maintenance medication used regularly to control inflammation and symptoms over time. Even if the client does not have symptoms, it is important to use the medication as prescribed. Skipping doses could reduce its effectiveness in managing the condition.

C. Use this medication to relieve an asthma attack.

This is incorrect. Fluticasone is a preventive medication, not a rescue medication. It does not provide immediate relief during an asthma attack. For acute attacks, the client should use a short-acting beta-agonist (SABA), such as albuterol, which works quickly to open the airways.

D. Check your heart rate before each dose.

Checking the heart rate is not typically necessary for fluticasone use. Fluticasone does not have significant effects on heart rate. However, if the client is taking other medications that could affect the heart rate (such as certain bronchodilators), they might need to monitor their heart rate, but it is not required for fluticasone itself.

Summary:

The correct instruction is B because oral thrush is a common side effect of inhaled corticosteroids like fluticasone. Checking the mouth for lesions daily helps detect and prevent this issue early.

Correct Answer C: Isoniazid can cause tingling of the hands.

Explanation of the Correct Answer:

C. Isoniazid can cause tingling of the hands.

Isoniazid is an antibiotic used to treat tuberculosis (TB), and one of its known adverse effects is peripheral neuropathy, which causes tingling, numbness, or a "pins and needles" sensation in the hands and feet. This is a result of nerve damage, often due to the drug’s effects on vitamin B6 (pyridoxine) metabolism. Patients on isoniazid are sometimes given vitamin B6 supplements to help prevent this side effect.

Why the Other Options Are Incorrect:

A. Isoniazid can cause ringing in the ears.

Ringing in the ears, or tinnitus, is not a typical side effect of isoniazid. It is more commonly associated with ototoxic drugs, like certain antibiotics (e.g., aminoglycosides) or chemotherapy agents, but not isoniazid.

B. Isoniazid can cause pain in the joints.

While joint pain is not a common adverse effect of isoniazid, it may rarely cause arthralgia (joint pain). However, this is not one of the main or characteristic side effects of the drug.

D. Isoniazid can cause yellowing of the skin.

Yellowing of the skin (jaundice) is more often related to liver dysfunction. While isoniazid can affect liver function (causing hepatotoxicity), it typically causes elevated liver enzymes, but yellowing of the skin is not a typical presentation. Jaundice may occur in severe liver toxicity, but it’s not a direct or common adverse effect of isoniazid alone.

Summary:

The correct answer is C because tingling in the hands (peripheral neuropathy) is a known adverse effect of isoniazid. Other side effects, such as pain in the joints, tinnitus, and jaundice, are not typical for this drug, although liver toxicity (which can lead to jaundice) is a known, though less frequent, serious side effect.

Correct Answer D: Avoid driving until effects are known.

Explanation of the Correct Answer:

Cyclobenzaprine is a centrally acting skeletal muscle relaxant commonly prescribed to treat acute muscle spasms associated with musculoskeletal conditions. It works by depressing motor activity primarily in the brainstem, leading to muscle relaxation. One of the most important safety considerations when starting cyclobenzaprine is its sedative effect, which can cause drowsiness, dizziness, and impaired cognitive or motor performance.

Because of these central nervous system effects, clients are advised to avoid driving, operating heavy machinery, or engaging in hazardous activities until they understand how the drug affects them individually. This is particularly crucial during the initial stages of treatment or when the dose is increased, as sedation may be pronounced.

Why the Other Options Are Incorrect:

A. Monitor for increased muscle spasms

Incorrect. Cyclobenzaprine is used to reduce muscle spasms, not increase them. If spasms worsen, it may indicate an ineffective response, but it is not a common or expected adverse effect of the drug.

B. Discontinue medication if nausea occurs.

Incorrect. Nausea is a relatively mild and non-life-threatening side effect of cyclobenzaprine. It should not be a reason for abrupt discontinuation. Instead, clients should report persistent or severe nausea to their provider, who may adjust the dose or provide supportive measures.

C. Expect urine to turn orange

Incorrect. Orange discoloration of urine is associated with medications like phenazopyridine, not cyclobenzaprine. This is not an expected or typical side effect of this muscle relaxant.

Summary:

The nurse should teach the client to avoid driving until the effects of cyclobenzaprine are known, due to its potential to cause sedation and impair motor and cognitive function, especially during the initial treatment period.

Correct Answer:

A. Calcium carbonate

E. Aluminum hydroxide

Explanation of the Correct Answers:

A. Calcium carbonate:

Calcium carbonate is a common antacid used to relieve symptoms of heartburn or indigestion. One of its side effects is constipation. Calcium can reduce the motility of the gastrointestinal tract, leading to slower bowel movements. This is especially notable in individuals who take high doses of calcium carbonate, such as those using it as a calcium supplement or frequently for acid reflux.

E. Aluminum hydroxide:

Aluminum hydroxide, often found in antacids like Maalox and Mylanta, can also cause constipation. It has a tendency to slow down the passage of stool through the intestines. This is one of the reasons that aluminum-based antacids are sometimes combined with magnesium-based ones to balance their side effects.

Why the Other Options Are Incorrect:

B. Magnesium oxide:

Magnesium oxide is used for its antacid properties but is more likely to cause diarrhea, not constipation. Magnesium salts, in general, have a laxative effect and can promote bowel movements. Therefore, magnesium oxide is not associated with constipation.

C. Magnesium hydroxide:

Like magnesium oxide, magnesium hydroxide is known for its laxative effect. It works by drawing water into the intestines to stimulate bowel movements. It is commonly used in over-the-counter medications like Milk of Magnesia, and constipation is not a typical side effect.

D. Sodium bicarbonate:

Sodium bicarbonate, commonly known as baking soda, is used to neutralize stomach acid and can temporarily relieve heartburn. It does not typically cause constipation. In fact, it is more likely to cause symptoms like belching or bloating due to the release of carbon dioxide. It does not slow down bowel movements in the way calcium or aluminum-based antacids do.

Summary:

The antacids that can cause constipation are calcium carbonate and aluminum hydroxide. Both of these medications can slow gastrointestinal motility, leading to fewer bowel movements. Magnesium-based antacids, on the other hand, typically cause diarrhea, while sodium bicarbonate does not usually affect bowel movements.

Correct Answer:

C. Mesalamine

E. Sulfasalazine

Explanation:

5-Aminosalicylates (5-ASAs) are a class of drugs commonly used to treat inflammatory bowel diseases (IBD) like ulcerative colitis and Crohn's disease. These drugs help to reduce inflammation in the intestines and are considered first-line therapies for managing mild to moderate IBD.

Mesalamine (also known as 5-ASA) is a primary medication in this class. It is used to reduce inflammation and treat symptoms of ulcerative colitis and other forms of IBD.

Sulfasalazine is also a 5-ASA medication. It is a prodrug that breaks down into sulfa (which has anti-inflammatory properties) and 5-ASA, which helps to reduce intestinal inflammation. Sulfasalazine is often used for ulcerative colitis and Crohn's disease.

Why the Other Options Are Incorrect:

A. Infliximab is not a 5-ASA. It is a biologic medication classified as a tumor necrosis factor (TNF) inhibitor. It works by targeting TNF-alpha, which plays a role in the inflammatory process of IBD. Infliximab is used for more moderate to severe cases of IBD, including Crohn’s disease and ulcerative colitis, but it is not a 5-ASA.

B. Adalimumab is also a TNF inhibitor and works in a similar way to infliximab. Like infliximab, it is used for moderate to severe IBD, but it is not classified as a 5-aminosalicylate.

D. Tofacitinib is a Janus kinase (JAK) inhibitor, which is used in ulcerative colitis and rheumatoid arthritis. It works by inhibiting the action of specific enzymes involved in the inflammatory process. It is not a 5-ASA.

Summary: 

The medications classified as 5-Aminosalicylates (5-ASAs) for the treatment of inflammatory bowel diseases in the provided options are Mesalamine and Sulfasalazine.

Correct Answers:

A. Clients should avoid live vaccines while on immunomodulator therapy.

C. Regular follow-up visits and bloodwork are essential for monitoring health status.

E. Clients should report any signs of infection immediately, such as fever or unusual fatigue.

Explanation of the Correct Answers:

Azathioprine is an immunosuppressant often used to treat autoimmune conditions like inflammatory bowel disease (IBD) and rheumatoid arthritis, and to prevent organ transplant rejection. Because it suppresses the immune system, specific safety precautions and monitoring are essential.

A. Clients should avoid live vaccines while on immunomodulator therapy.

Correct. Live vaccines (such as MMR, varicella, and intranasal flu vaccine) can pose a serious risk of infection in immunosuppressed individuals. Clients should be instructed to avoid live vaccines unless cleared by their healthcare provider.

C. Regular follow-up visits and bloodwork are essential for monitoring health status.

Correct. Azathioprine can cause bone marrow suppression, liver toxicity, and increased infection risk. Regular CBCs and liver function tests are essential to monitor for leukopenia, anemia, or hepatotoxicity.

E. Clients should report any signs of infection immediately, such as fever or unusual fatigue.

Correct. Because azathioprine weakens the immune system, clients are at increased risk of infections. Fever, sore throat, or unexplained fatigue should be reported immediately, as they may indicate a serious infection.

Why the Other Options Are Incorrect:

B. It is safe to receive live vaccines if administered at least 30 days after starting the medication.

Incorrect. Live vaccines are generally contraindicated during immunosuppressive therapy regardless of timing, unless specifically advised by a specialist.

D. Handwashing is not necessary if the client avoids sick individuals.

Incorrect. Frequent handwashing is essential for infection prevention, especially when the immune system is compromised. Avoiding sick individuals is not a substitute for good hygiene practices.

F. Clients can discontinue their medication if they feel well after a few weeks.

Incorrect. Azathioprine must be taken consistently as prescribed. Stopping without medical guidance can lead to relapse or rejection in transplant patients. Always consult a healthcare provider before making changes.

Summary:

Correct patient teaching for azathioprine includes avoiding live vaccines, attending regular bloodwork appointments, and promptly reporting infection signs. Stopping the medication without medical advice or neglecting hygiene are unsafe practices.

Correct Answer:

A. The medication will open the airways.

D. The medication will prevent wheezing.

E. The medication will decrease coughing episodes.

Explanation of the Correct Answers:

A. The medication will open the airways.

Albuterol is a beta-2 agonist that works by relaxing the smooth muscles around the airways, leading to bronchodilation. This helps open the airways, making it easier for the person to breathe, which is why albuterol is used in the treatment of conditions like asthma and COPD.

D. The medication will prevent wheezing.

By opening the airways, albuterol can prevent wheezing, which is commonly caused by constricted or narrowed airways. Wheezing is a hallmark symptom of asthma and other respiratory conditions, and albuterol helps alleviate it by improving airflow.

E. The medication will decrease coughing episodes.

Although albuterol is primarily used to alleviate wheezing and shortness of breath by opening the airways, it can indirectly reduce coughing episodes as well. This is because coughing can often be triggered by constricted or narrowed airways, and by improving airflow, albuterol can make breathing easier, thus reducing coughing that may be associated with bronchoconstriction.

Why the Other Options Are Incorrect:

B. The medication will reduce inflammation.

Albuterol is a bronchodilator, not an anti-inflammatory drug. While it helps open up the airways, it does not directly reduce inflammation in the airways. Medications like steroids are used for that purpose, but albuterol itself does not have an anti-inflammatory effect.

C. The medication will stimulate flow of mucus.

Albuterol does not stimulate mucus production. It works by relaxing the muscles of the airways to allow for easier breathing, but it does not directly affect mucus production or clearance. Mucus flow and secretion are typically managed by other types of treatments, such as expectorants.

Summary:

Albuterol opens the airways, prevents wheezing, and can reduce coughing by improving airflow. It does not directly reduce inflammation or stimulate mucus flow. Therefore, the correct answers are A, D, and E.