NCLEX-PN › Other Pharmacological Drugs
The nurse prepares to administer medications on the psychiatric unit. The patient is prescribed phenelzine sulfate for depression. Which of the following is the nurse’s priority education when administering this medication?
Avoid foods with tyramine
Effect of medication takes 3-4 weeks to work
Avoid tricyclic medications until 3 weeks after stopping
Wear sunblock
Potentiates alcohol and other medications
Phenelzine is a monoamine oxidase inhibitor (MAOI) that treats depression. Patients who take MAOIs should avoid foods with tyramine due to an increased risk for hypertensive crisis. Tyramine-rich foods include those that are fermented, heavily marinated, pickled, smoked, or heavily marinated, also, chocolate and alcoholic beverages have significant amounts of tyramine. In addition to education about diet modification, nurses must educate patients of the signs of hypertensive crisis, which are headache, sweating, palpitations, stiff neck, and intracranial hemorrhage. All of the other listed patient educations are essential, but the priority is to avoid tyramine due to the risk for hypertensive crisis, which is life-threatening.
The psychiatric nurse cares for a patient with major depressive disorder admitted after a suicide attempt. The primary care provider has prescribed fluoxetine, which the patient has never taken before. Which of the following statements is important for the nurse to say to the patient?
“This medication takes at least 4 weeks to work.”
“You may experience changes in appetite and weight.”
“You could begin to feel more anxious.”
“You should take this medication in the morning because it can cause insomnia.”
“You may experience changes in your bowel movements such as diarrhea or constipation.”
Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) commonly prescribed to patients diagnosed with depression. It may cause changes in appetite and weight, increase anxiety and insomnia, or cause bradycardia or palpitations. It is most important for the nurse to educate the patient that the therapeutic effect of fluoxetine may take up to 4 weeks, as the patient has a previous suicide attempt, and may experience suicide ideation before the effect occurs.
You are the nurse at a psychiatry clinic taking care of a 47-year old male who complains of three months of depressed mood and fatigue. His physician starts him on venlafaxine. Which of the following best describes the mechanism of action of venlafaxine?
Serotonin-norepinephrine reuptake inhibitor (SNRI)
Selective serotonin reuptake inhibitor (SSRI)
Monoamine oxidase inhibitor (MAOI)
GABA agonist
Beta-adrenergic blocker
The correct answer is "Serotonin-norepinephrine reuptake inhibitor (SNRI)." This is correct because venlafaxine functions by blocking the reuptake of both serotonin and norepinephrine, and thus is classified as a serotonin-norepinephrine reuptake inhibitor (SNRI). Venlafaxine is used to treat a number of conditions including depression, anxiety, panic attacks, and social phobia, among others. In addition to its anti-depressant properties, it is also useful in that it can provide the benefit of increased energy in some patients due to the norepinephrine reuptake inhibition (effectively increasing the effect of norepinephrine).
Selective serotonin reuptake inhibition (SSRI) is incorrect because venlafaxine is an SNRI, not an SSRI. An example of an SSRI is fluoxetine.
Monoamine oxidase inhibition (MAOI) is incorrect because venlafaxine is an SNRI, not an MAOI. An example of an MAOI is phenelzine.
An example of a GABA agonist is phenobarbital, a barbiturate.
An example of a beta-adrenergic blocker is propranolol.
You are the nurse taking care of a 24-year old female with major depressive disorder. She is started on phenelzine, a monoamine oxidase inhibitor (MAOI). To avoid serious adverse effects, including hypertensive crisis, you should warn her to avoid which of the following foods?
Aged cheeses
Carrots
Green, leafy vegetables
Grapefruit juce
Beets
The correct answer is "aged cheeses." This is the correct answer because MAOI's, when combined with food or drink products containing the metabolite, tyramine, have the potential to cause serious adverse effects including hypertensive crisis. Tyramine is found most commonly in aged cheeses and cured meats. Thus, since this patient is taking an MAOI, she should be advised to avoid aged cheeses.
Carrots, beets, grapefruit juice, and green, leafy vegetables do not need to be avoided in patients taking MAOI's.
Allopurinol is used for what condition?
Gout
Hypertension
Type II diabetes
Kidney stones
Allopurinol is a purine analog and xanthine oxidase inhibitor used in the treatment of chronic gout.
A 26 year old pregnant client presents to labor and delivery in premature labor, the doctor has ordered a tocolytic medication to help in stopping the contractions.
Which of the following medications is effective in managing premature labor contractions?
Terbutaline sulfate
Pitocin
Calcium gluconate
Naprosyn
Misoprostol
Terbutaline sulfate is a tocolytic agent, as well as a bronchodilator effective in stopping premature labor contractions. Both Pitocin and Misoprostol are used to induce labor, calcium gluconate in labor is used to reverse magnesium sulfate another tocolytic. Naprosyn is an NSAID.
Which of the following drugs is used in the treatment of osteoporosis?
Alendronic acid
Infliximab
Sitagliptin
Budesonide/formoterol
Alendronic acid (trade name Fosamax) is a bisphosphonate used in the treatment of osteoporosis. Bisphosphonates reduce bone loss by encouraging apoptosis in osteoclasts.
Infliximab is a tumor necrosis factor-alpha (TNF-alpha) blocker used in the treatment of rheumatoid arthritis and several other autoimmune conditions. Sitagliptin (trade name Januvia) is a diabetes medication. Budesonide/formoterol (trade name Symbicort) is a combination long acting beta agonist and corticosteroid used in the treatment of asthma.
A client being treated for type II diabetes has recently been prescribed an oral hyperglycemic medication and has inquired how the medications will keep his blood sugar levels under control. The nurse informs the patient the medication prescribed will reduce glucose production by the liver and increase insulin sensitivity but will not increase insulin production.
Based on this description, which diabetic medication has this client been prescribed?
Metformin
Exenatide
Glipizide
Sitagliptin
Glyburide
The only medication mentioned that does not actually stimulate insulin production is Metformin. This medication is a Biguanide, it's mechanism of action includes decreasing hepatic glucose production, and increases insulin sensitivity.
When Allopurinol is prescribed to a client, it is best for the nurse to include the following instructions:
To drink 3000 mL of fluid a day
To take the medication on an empty stomach
That the effect of the medication will occur immediately
That if swelling of the lips occurs, this is a normal expected response
The nurse should instruct a patient on Allopurinol to drink 3000 mL of fluid a day to reduce the risk of kidney stone formation.
Which of the following is a potential side effect of prednisone?
All of these
Adrenal suppression
Weight gain
Hyperglycemia and diabetes
There are many potential side effects of prednisone, including all those listed in the answer choices, headache, fatigue, acne, seizures, upset stomach, changes in mood, difficulty breathing, dry cough, vomiting, depression, heartburn, muscle weakness, irregular heart beat, tremors, inability to properly thermoregulate, and many others.