NCLEX-PN pharma

Treat hyperkalemia

Sodium polystyrene sulfonate (Kayexalate) is a cation exchange resin used in the treatment of hyperkalemia. The resin either passes through the intestine or is retained in the colon. It releases sodium ions in exchange for primarily potassium ions. The therapeutic effect occurs 2 to 12 hours after oral administration and longer after rectal administration.

Treat serum calcium toxicity

Calcitonin, a thyroid hormone, decreases the plasma calcium level by inhibiting bone resorption and lowering the serum calcium concentration.

Treat tetany due to acute hypocalcemia

Calcium gluconate and calcium chloride are medications used in the treatment of tetany, which occurs as a result of acute hypocalcemia

used in management of preeclampsia

Magnesium toxicity can occur from magnesium sulfate therapy. Signs of magnesium sulfate toxicity relate to central nervous system (CNS) depressant effects of the medication and include respiratory depression, loss of deep tendon reflexes, sudden drop in fetal heart rate and/or maternal heart rate and blood pressure. Therapeutic serum levels of magnesium are 4 to 7 mEq/L. Proteinuria of 3+ is likely to be noted in a client with preeclampsia.

Treat hypertension

• Lisinopril is an antihypertensive, angiotensin-converting enzyme inhibitor (ACE inhibitor).
• The usual dosage range is 20 to 40 mg/day. Adverse effects include headache, dizziness, fatigue, orthostatic hypotension, tachycardia, and angioedema.
• Specific client teaching points include taking one pill a day, not stopping the medication without consulting the physician, and monitoring for side effects and adverse reactions.
• The client should notify the physician if side effects occur.

Treat burn injuries

Furacin is applied topically to the burn and has a broad spectrum of antibiotic activity. It is used in a burn injury when bacterial resistance to other agents is a real or potential problem. A film of 1/16 inch is applied directly to the burn. Saline-soaked dressings are not used.

Treat burn injuries

Mafenide acetate is bacteriostatic for both gram-negative and gram-positive organisms and is used to treat burn injuries to reduce bacteria present in avascular tissues. The client should be informed that the medication will cause local discomfort and burning.

Mafenide acetate can suppress renal excretion of acid and cause acidosis, evidenced by hyperventilation. Clients receiving this treatment should be monitored for acid-base status and, if the acidosis becomes severe, the medication is discontinued for 1 to 2 days.

Treat wound (purulent wounds and necrotic wounds)

Dakin solution is a chloride solution that is used for irrigating and cleaning necrotic or purulent wounds. It can be used for packing necrotic wounds. It cannot be used to pack purulent wounds, because the solution is inactivated by copious pus. It should not come into contact with healing or normal tissue, and it should be rinsed off immediately if used for irrigation. Solutions are unstable and must be prepared fresh for each use.

Treat acne

Tretinoin decreases cohesiveness of the epithelial cells, increasing cell mitosis and turnover. It is potentially irritating particularly when used correctly. Within 48 hours of use, the skin generally becomes red and begins to peel.

Tretinoin is applied liberally to the skin. The hands are washed thoroughly immediately after applying. Therapeutic results should be seen after 2 to 3 weeks but may not be optimal until after 6 weeks. The skin needs to be cleansed thoroughly before applying the medication.

Treat severe acne

Isotretinoin is administered two times daily for 15 to 20 weeks. If needed, a second course may be given, but not until 2 months have elapsed after completing the first course.

Isotretinoin can elevate triglyceride levels. Blood triglyceride levels should be measured prior to treatment and periodically thereafter until the effects of the medication on the triglycerides have been evaluated.

Vitamin A, a derivative of isotretinoin, can produce generalized intensification of isotretinoin toxicity. Because of the potential for increased toxicity, vitamin A supplements should be discontinued prior to isotretinoin therapy.

Treat ulcer

The wound should be cleansed with a sterile solution and gently patted dry. A thin layer of Elase is applied and covered with a petrolatum gauze. If a dry powder is used, the solution should be prepared just prior to use.

Treats ulcer

The wound should be cleansed with a sterile solution prior to treatment. The nurse then thoroughly moistens the wound with normal saline or sterile water, applies a thin film of Travase extending ¼ to ½ inch beyond the area to be debrided, and then applies a loose thin dressing. The ointment should be refrigerated.

Treat acne (moderate to severe)

Azelaic acid is a topical medication used to treat mild to moderate acne. It appears to work by suppressing the growth of Propionibacterium acnesand by decreasing proliferation of keratinocytes.

Treat burn injuries

Collagenase is used to promote debridement of dermal lesions and severe burns. It is applied once daily and covered with a sterile dressing.

Treat ulcer

Debrisan is a cleansing rather than a debriding agent. It is effective in wet wounds only. It is not packed tightly into the wound because maceration of surrounding tissue may result.

Treat psoriasis

Coal tar is used to treat psoriasis and other chronic disorders of the skin. It suppresses DNA synthesis, mitotic activity, and cell proliferation. It has an unpleasant odor, can frequently stain the skin and hair, and can cause phototoxicity. Systemic toxicity does not occur.

Treat herpes simplex

Acyclovir is a topical antiviral agent that inhibits DNA replication in the virus. It has activity against herpes simplex virus types 1 and 2, varicella-zoster virus, Epstein-Barr virus, and cytomegalovirus. Triple antibiotic would not be effective in treating herpesvirus. Mupirocin is a topical antibacterial active against impetigo caused by staphylococcus or streptococcus. Masoprocol is a keratolytic.

Salicylic acid is readily absorbed through the skin and systemic toxicity (salicylism) can result. Symptoms include tinnitus, hyperpnea, dizziness, and psychological disturbances. Constipation and diarrhea are not associated with salicylism.

Topical glucocorticoids can be absorbed in sufficient amounts to produce systemic toxicity. Principal concerns are growth retardation (in children), and adrenal suppression in all age groups.

Topical glucocorticoids can be absorbed into the systemic circulation. Absorption is higher from regions where the skin is especially permeable (scalp, axilla, face, eyelids, neck, perineum, genitalia), and lower from regions where penetrability is poor (back, palms, soles).

Clients should be advised not to use occlusive dressings (bandages or plastic wraps) to cover the affected site following the application of the topical glucocorticoid, unless the physician specifically prescribes wound coverage.

Lindane can penetrate the intact skin and can cause convulsions if absorbed in sufficient quantities. Clients at highest risk for convulsions are premature infants, children, and clients with preexisting seizure disorders. Lindane should not be used on pediatric clients unless safer medications have failed to control the infection.

Lindane is applied in a thin layer to the entire body below the head. No more than 30 g (1 oz) should be used. The medication is removed by washing 8 to 12 hours later. Usually, only one application is required.

The instructions for the use of permethrin include wash, rinse, and towel-dry the hair; apply sufficient volume to saturate the hair and scalp; allow to remain on the hair 10 minutes and then rinse with water.

Myoflex is one of the many products used for the temporary relief of muscular aches, rheumatism, arthritis, sprains, and neuralgia. These types of products contain combinations of antiseptics, local anesthetics, analgesics, and counterirritants. A heating pad should not be applied because irritation or burning of the skin may occur. These medications do not act in a systemic manner. They are not prescribed to cause the skin to peel and, if this sort of reaction occurs, the physician should be notified.

Protective dressings such as DuoDerm are designed to be left in place for 7 days unless leakage occurs around the dressing.

Cyclophosphamide is an antineoplastic medication of the alkylating classification. Medications in this classification are cell cycle-phase nonspecific and affect all phases of the reproductive cell cycle. Cell phase-specific medications affect cells only during a certain phase of the reproductive cycle.

Hemorrhagic cystitis is a toxic effect that can occur with the use of cyclophosphamide. The client needs to be instructed to drink copious amounts of fluid during the administration of this medication. Clients should also monitor urine output for hematuria. The medication should be taken on an empty stomach, unless gastrointestinal upset occurs. Hyperkalemia can result from the use of the medication; therefore, the client would not be encouraged to increase potassium intake. The client would not be instructed to alter his or her sodium intake.

Cisplatin is an alkylating medication and vincristine is a vinca alkaloid. Alkylating medications are cell cycle phase-nonspecific. Vinca alkaloids are cell cycle phase-specific. Combinations of medications are used to enhance tumoricidal effects. Use of combination medications decrease medication resistance, increase destruction of cancer cells, and reduce medication toxicity.

Allopurinol, an antigout medication, is used with chemotherapy to prevent or treat hyperuricemia. It may be prescribed for use in mouthwash following fluorouracil (Adrucil) therapy to prevent stomatitis. Allopurinol is not used to prevent diarrhea.

Allopurinol is an antigout medication. It decreases uric acid production by inhibiting the enzyme xanthine oxidase, and reduces uric acid concentrations in both serum and urine.

Allopurinol is an antigout medication that may increase the effect of oral anticoagulants. Warfarin sodium (Coumadin) is an anticoagulant, and if this medication was prescribed for the client, the nurse would question the order. Ergonovine maleate is an antimigraine medication. Pentazocine is an opioid analgesic. Mebendazole is an anthelmintic.

Clients taking allopurinol are encouraged to drink 3000 mL of fluid a day. A full therapeutic effect may take 1 week or longer. Allopurinol is to be given with or immediately following meals or milk to prevent gastrointestinal irritation. If the client develops a rash, irritation of the eyes, or swelling of the lips or mouth, he or she should contact the physician, because this may indicate hypersensitivity.

Allopurinol (Zyloprim) is an antigout medication. It decreases uric acid production by inhibiting xanthine oxidase, an enzyme. The medication can be taken with or immediately following food intake. The client should drink at least 2000 to 3000 mL of fluid daily to prevent the development of uric acid stones. Alcohol intake needs to be avoided (not limited), because alcohol can increase uric acid levels. The client is also instructed to report side effects such as a rash to the physician. A complete blood cell count and renal and liver function studies may be prescribed to monitor for adverse effects of the medication.

Busulfan is as alkylating medication used in the treatment of acute myelocytic leukemia and in the palliative treatment of chronic myelogenous leukemia. Hyperuricemia can result from the use of this medication because it may produce uric acid nephropathy, renal stones, and acute renal failure.

Busulfan can cause an increase in the uric acid level. Hyperuricemia can produce uric acid nephropathy, renal stones, and acute renal failure.

Cardiotoxicity and/or cardiomyopathy manifested as congestive heart failure (CHF) is a toxic effect of daunorubicin. Bone marrow depression is also a toxic effect. Nausea and vomiting is a frequent side effect associated with the medication that begins a few hours after administration and lasts 24 to 48 hours. Fever is a frequent side effect and diarrhea can occur occasionally.

Plicamycin is an antitumor-antibiotic agent. Because plicamycin affects bleeding time, the use of aspirin, anticoagulants, and thrombolytic agents should be avoided. Warfarin is an anticoagulant and the risk of hemorrhage is increased if it is administered during plicamycin therapy. Allopurinol, an antigout medication, may be used with chemotherapy to prevent or treat hyperuricemia secondary to blood dyscrasias caused by cancer chemotherapy. Acetaminophen may be used to treat mild discomfort. Ondansetron is an antiemetic used to prevent or treat nausea and vomiting during chemotherapy.

Bleomycin sulfate is an antineoplastic medication that can cause interstitial pneumonitis that can progress to pulmonary fibrosis. Pulmonary function studies, along with hematologic, hepatic, and renal function tests, need to be monitored. The nurse needs to monitor for dyspnea, which may indicate pulmonary toxicity. The medication will be discontinued immediately if pulmonary toxicity occurs.

Cytarabine is an antimetabolite. Antimetabolites are classified as cell cycle phase-specific. Alkylating medications affect all phases of the cell reproductive cycle. Hormone medications suppress the immune system and block normal hormones in hormone-sensitive tumors.

Because antineoplastic medications lower the body's resistance, clients must be informed not to receive immunizations or vaccines without a physician's approval. Aspirin and aspirin-containing products need to be avoided to minimize the risk of bleeding. Alcohol needs to be avoided to minimize the risk of toxicity.

Stomatitis, ulceration in the mouth, can occur as a result of the administration of antineoplastic medications. The client should be instructed to examine the mouth daily and to report any signs of ulceration. If stomatitis occurs, the client should be instructed to rinse the mouth with diluted baking soda or saline. Food and fluid is important and should not be restricted. The client should avoid toothbrushing and flossing when stomatitis is severe. Lemon and glycerin swabs may cause pain and further irritation.

High concentrations of methotrexate damage normal cells.

To save normal cells, leucovorin is given, which is known as leucovorin rescue.

A side effect specific of vincristine is peripheral neuropathy, which occurs in nearly every client. This can be manifested as numbness and tingling in the fingers and toes. Constipation rather than diarrhea is most likely to occur with this medication, although diarrhea may occur occasionally. Hair loss occurs with nearly all of the antineoplastic medications. Chest pain is unrelated to this medication.

Alopecia, hair loss, can occur following the administration of many antineoplastic medications. Alopecia is reversible, but new hair growth may have a different color and texture.

Asparaginase is an antineoplastic agent, and is contraindicated if hypersensitivity exists, in pancreatitis, or if the client has a history of pancreatitis. The medication impairs pancreatic function, and pancreatic function tests should be performed before therapy begins and when a week or more has elapsed between the administration of the doses. The client needs to be monitored for signs of pancreatitis, which include nausea, vomiting, and abdominal pain.

Tamoxifen is an antineoplastic medication that competes with estradiol for binding to estrogen in tissues containing high concentrations of receptors. It is used in the treatment of metastatic breast carcinoma in women and men. It is also effective in delaying the recurrence of cancer following mastectomy. It reduces DNA synthesis and estrogen response.

Tamoxifen may increase calcium, cholesterol, and triglyceride levels. The nurse should monitor for hypercalcemia while the client is taking this medication. Signs of hypercalcemia include increased urine volume, excessive thirst, nausea, vomiting, constipation, hypotonicity of muscles, and deep bone or flank pain. Leukopenia, weight gain, and hypertension are most likely to occur.

Megestrol acetate, and antineoplastic medication, suppresses the release of luteinizing hormone from the anterior pituitary by inhibiting pituitary function and regressing tumor size. It is used with caution if the client has a history of thrombophlebitis.

Older clients are especially susceptible to the central nervous system (CNS) side effects of cimetidine. The most frequent of these is confusion. Less common CNS side effects include headache, dizziness, drowsiness, and hallucinations.

Cisplatin (Platinol-AQ) is an alkylating medication. Alkylating medications are cell cycle phase-nonspecific medications that affect the synthesis of DNA by causing cross-linking of DNA to inhibit cell reproduction. Cisplatin may cause ototoxicity, tinnitus, hypokalemia, hypocalcemia, hypomagnesemia, and nephrotoxicity. Amifostine (Ethyol) may be administered before cisplatin to reduce the potential for renal toxicity.

NPH is an intermediate-acting insulin. The onset of action is 1 to 2 hours, it peaks in 6 to 14 hours, and its duration of action is 24 hours. Hypoglycemic reactions most likely occur during peak time.

Unopened vials of insulin should be stored under refrigeration until needed. Vials should not be frozen. Open vials in use may be kept at room temperature and should be kept away from heat and direct light.

An unrefrigerated insulin vial will maintain its potency for up to 1 month. Direct sunlight and heat must be avoided.

Mixtures of insulin in prefilled syringes should be stored in a refrigerator, where they will be stable for 1 week. The syringe should be stored vertically, with the needle pointing up, to avoid clogging the needle. Prior to administration, the syringe should be agitated gently to resuspend the insulin.

Protropin is a growth stimulator used in the long-term treatment of growth failure resulting from growth hormone deficiency. It stimulates linear growth, increases the number and size of muscle cells, and red cell mass. It affects carbohydrate metabolism by antagonizing the action of insulin, increasing mobilization of fats, and increasing cellular protein synthesis.

Water intoxication or hyponatremia is an adverse reaction to DDAVP. Early signs include drowsiness, listlessness, and headache. Decreased urination, rapid weight gain, confusion, seizures, and coma may also occur in overhydration.

Oral doses of levothyroxine should be taken on an empty stomach to enhance absorption. The medication should be taken in the morning before breakfast.

Excessive doses of levothyroxine can produce signs and symptoms of hyperthyroidism (thyrotoxicosis). These include tachycardia, angina, tremors, nervousness, insomnia, hyperthermia, heat intolerance, and sweating. The client should be instructed to notify the physician if these occur.

Laboratory determination of the serum thyroid-stimulating hormone level (TSH) is an important means of evaluation of therapy with levothyroxine. Effective therapy will cause the elevated TSH levels to decrease. These levels will begin their decline within hours of the onset of therapy and will continue to drop as plasma levels of thyroid hormone build up. If an adequate dosage is established, TSH levels will remain suppressed for the duration of the therapy. Although energy levels are expected to increase, the primary expected outcome is measured by thyroid hormone levels.

For most hypothyroid clients, replacement therapy must be continued for life. Treatment provides symptomatic relief but does not produce a cure. The client should be told that although therapy will improve symptoms, these improvements do not constitute a reason to interrupt or discontinue the medication.

PTU inhibits thyroid hormone synthesis and is used to treat hyperthyroidism or Graves' disease. Myxedema indicates hypothyroidism. Cushing's syndrome and Addison's disease are disorders related to adrenal function.

An adverse effect of PTU is agranulocytosis. The client needs to be informed of the early signs of this adverse effect, which includes fever or sore throat. Drowsiness is an occasional side effect of the medication. Polyuria and dry mouth are unrelated to this medication.

Lypressin is administered by the intranasal route. It is used for diabetes insipidus. The usual adult dosage is one or two sprays into each nostril four times daily.

Lugol solution is administered to hyperthyroid individuals in preparation for thyroidectomy to suppress thyroid function. Initial effects develop within 24 hours; peak effects develop in 10 to 15 days

Excessive doses of fludrocortisone cause retention of sodium and water and excessive excretion of potassium, resulting in expansion of blood volume, hypertension, cardiac enlargement, edema, and hypokalemia. The client needs to be informed about the signs of sodium and water retention, such as unusual weight gain or swelling of the feet or lower legs. If these signs occur, the physician needs to be notified.

The client should be instructed to take oral calcium 30 to 60 minutes after meals to promote absorption. The client should take the medication with a full glass of water.

The client taking an antihypocalcemic medication should be instructed to avoid eating foods that can suppress calcium absorption. These foods include Swiss chard, beets, bran, and whole-grain cereals.

Glucocorticoids should be administered before 9 a.m., and the client should be instructed to do so. Administration at this time helps minimize adrenal insufficiency and mimics the burst of glucocorticoids released naturally by the adrenals each morning.

Sildenafil citrate (Viagra) enhances the vasodilation effect of nitric oxide in the corpus cavernosus of the penis, thus sustaining an erection. Because of the effect of the medication, it is contraindicated with concurrent use of organic nitrates and nitroglycerin. It is not contraindicated with the use of vitamins. Neuralgia and insomnia are side effects of the medication.

When preparing a mixture of Regular insulin with another insulin preparation, the Regular insulin should be drawn into the syringe first. This sequence will avoid contaminating the vial of Regular insulin with insulin of another type.

The effect of lispro insulin begins within 5 minutes of subcutaneous injection and persists for 2 to 4 hours. Lispro insulin acts more rapidly than Regular insulin but has a shorter duration of action. Because of its rapid onset, it can be administered immediately before eating. In contrast, Regular insulin is generally administered 30 to 60 minutes before meals.

When alcohol is combined with tolbutamide, a disulfiram-like reaction may occur. This syndrome includes flushing, palpitations, and nausea. Also, alcohol can potentiate the hypoglycemic effects of tolbutamide. Clients must be warned about alcohol consumption while taking this medication.

Metamucil is a bulk-forming laxative. It should be taken with a full glass of water or juice, followed by another glass of liquid. This will help prevent impaction of the medication in the stomach or small intestine. The other options are incorrect.

If the client experiences tardive dyskinesia (rhythmic movements of the face or limbs), the client should stop the medication and call the physician. These side effects may be irreversible. Excitability is not a side effect of this medication. Anxiety, irritability, and dry mouth are side effects that are not as harmful to the client.

The client should be taught to take this medication 30 minutes before meals. This allows the medication time to begin working before the client takes in food, which requires digestion and movement. A dose is also usually prescribed to be taken at bedtime.

Trimethobenzamide is an antiemetic agent that is used in the treatment of nausea and vomiting. The other options are incorrect.

Ondansetron is an antiemetic that is used in the treatment of postoperative nausea and vomiting, as well as nausea and vomiting associated with chemotherapy. The other options are incorrect.

Magnesium citrate is available as an oral solution. It is used commonly as a laxative following certain studies of the GI tract. It should be served chilled, and should not be allowed to stand for prolonged periods. This would reduce the carbonation and make the solution even less palatable.

The nurse would monitor the client for blurred vision as a frequent side effect of prochlorperazine. Other frequent side effects of this phenothiazine-type antiemetic and antipsychotic are dry eyes, dry mouth, and constipation.

Pancrelipase is a pancreatic enzyme used in clients with pancreatitis as a digestive aid. The medication should reduce the amount of fatty stools (steatorrhea). Another intended effect could be improved nutritional status. It is not used to treat abdominal pain or heartburn. It could result in weight gain, but should not result in weight loss if it is aiding in digestion.

Aluminum hydroxide tablets should be chewed thoroughly before swallowing. This prevents them from entering the small intestine undissolved. They should not be swallowed whole. Antacids should be taken at least 1 hour apart from other medications to prevent interactive effects. Constipation is a side effect of use of aluminum products, but it is not correct for the client to take a laxative with each dose of aluminum hydroxide tablets. This promotes laxative abuse; the client should first try other means to prevent constipation.

Calcium carbonate is used as an antacid for the relief of heartburn and indigestion in a client with a duodenal ulcer. It can also be used as a calcium supplement or to bind phosphorus in the gastrointestinal tract with renal failure. Proper calcium levels are needed for proper neurological function.

Sodium bicarbonate is an electrolyte modifier and antacid. It would further aggravate metabolic alkalosis.

The medication should be scheduled for administration 1 hour before meals and at bedtime. The medication is timed to allow it to form a protective coating over the ulcer before food intake stimulates gastric acid production and mechanical irritation. The other options are incorrect.

A single daily dose of ranitidine is scheduled to be given at bedtime. This allows for a prolonged effect, and the greatest protection of the gastric mucosa.

Omeprazole is a gastric pump inhibitor and is classified as an antiulcer agent. The intended effect of the medication is relief of pain from gastric irritation, often referred to as heartburn by clients.

Cascara sagrada is a laxative that causes nausea and abdominal cramps as the most frequent side effects. Other health problems are not determined based on a single symptom.

Most rapid results from bisacodyl occur when it is taken on an empty stomach. It will not have a rapid effect if taken with a large meal. If it is taken at bedtime, the client will have a bowel movement in the morning. Taking the medication with two glasses of juice will not add to its effect.

Loperamide is an antidiarrheal agent. It is commonly administered after loose stools. It is used in the management of acute diarrhea and also in chronic diarrhea, such as with inflammatory bowel disease. It can also be used to reduce the volume of drainage from an ileostomy.

The client should not exceed the recommended dose because it may be habit-forming. The medication is an antidiarrheal, and therefore should not be taken with a laxative. Side effects of the medication include dry mouth and drowsiness.

Dimenhydrinate is used to treat and prevent the symptoms of dizziness, vertigo, nausea, and vomiting that accompany motion sickness. The other options are incorrect.

Docusate sodium is a stool softener that promotes the absorption of water into the stool, producing a softer consistency of stool. The intended effect is relief or prevention of constipation. The medication does not relieve abdominal pain, stop gastrointestinal bleeding, or decrease the amount of fat in the stools.

Albuterol is a bronchodilator of the adrenergic type. The nurse checks the respiratory pattern, pulse, and blood pressure before and during therapy. The color, character and amount of sputum are also noted.

Isoproterenol is an adrenergic bronchodilator. Side effects can include tachycardia, hypertension, chest pain, dysrhythmias, nervousness, restlessness, and headache, among others. The nurse monitors for these effects during therapy.

Metaproterenol is a bronchodilator. Beclomethasone is a glucocorticoid. Bronchodilators are always administered before glucocorticoids, when both are to be given on the same time schedule. This allows for widening of the air passages by the bronchodilator, which then makes the glucocorticoid more effective.

Theorphylline is a xanthine bronchodilator. The nurse teaches the client to limit the intake of xanthine-containing foods while taking this medication. These include coffee, cola, and chocolate.

The client taking a single daily dose of theophylline, a xanthine bronchodilator, should take the medication early in the morning. This enables the client to have maximal benefit from the medication during daytime activities. Additionally, this medication causes insomnia. The client should take in at least 2 L of fluid per day to decrease viscosity of secretions. The client should check with the physician before changing brands of the medication. The client also checks with the physician before taking OTC cough, cold, or other respiratory preparations because they could cause interactive effects, increasing the side effects of theophylline and causing dysrhythmias.

Theophylline (Theo-Dur) is a xanthine bronchodilator that dilates the airways of the respiratory tree and relaxes the smooth muscles of the bronchi. Xanthine bronchodilators stimulate the central nervous system and respiratory system, dilate coronary and pulmonary vessels, causing diuresis, and relax smooth muscle. Side effects include palpitations and tachycardia, dysrhythmias, restlessness, nervousness, tremors, and gastrointestinal effects such as anorexia, nausea, and vomiting. Other side effects include headaches and dizziness.

A frequent side effect of brompheniramine, an antihistamine, is drowsiness or sedation. Others include blurred vision, hypertension (and sometimes hypotension), dry mouth, constipation, urinary retention, and sweating.

Brompheniramine is an antihistamine, which provides relief of symptoms caused by allergy. Antihistamines should be discontinued for at least 3 days (72 hours) before allergy skin testing to avoid false negative readings. This client should have the appointment rescheduled for 3 days after discontinuing the medication.

Acetylcysteine can be given orally or by nasogastric tube to treat acetaminophen overdose, or it may be given by inhalation for use as a mucolytic. The nurse administering this medication as a mucolytic should have suction equipment available in case the client cannot manage to clear the increased volume of liquefied secretions.

Acetylcysteine can be given orally or by nasogastric tube to treat acetaminophen overdose, or it may be given by inhalation for use as a mucolytic. Prior to giving the medication as an antidote to acetaminophen, the nurse ensures that the client's stomach is empty through emesis or gastric lavage. The solution is diluted in cola, water, or juice to make the solution more palatable. It is then administered orally or by nasogastric tube.

The antidote for acetaminophen (Tylenol) is acetylcysteine (Mucomyst). Auranofin (Ridaura) is a gold preparation used in rheumatoid arthritis. Fludarabine (Fludara) and pentostatin (Nipent) are antineoplastic agents.Because acetylcysteine (Mucomyst) has a pervasive odor of rotten eggs, it must be disguised in a flavored ice drink, and is preferably drunk through a straw to minimize contact with the mouth. It is not administered by the intramuscular or subcutaneous route.

Guaifenesin is an expectorant. It should be taken with a full glass of water to decrease viscosity of secretions. Sustained-release preparations should not be broken open, crushed, or chewed. The medication may occasionally cause dizziness, headache, or drowsiness as side effects. The client should contact the physician if the cough lasts longer than 1 week or is accompanied by fever, rash, sore throat, or persistent headache.

Naloxone is an antidote to opioids, and may also be given to the postoperative client to treat respiratory depression. When given to the postoperative client for respiratory depression, it may also reverse the effects of analgesics. Therefore, the nurse must check the client for a sudden increase in the level of pain experienced.

Signs of opioid withdrawal include increased temperature and blood pressure, abdominal cramping, vomiting, and restlessness. They can occur at any time, from a few minutes to a few hours after administration of naloxone, depending on the opioid involved, the degree of dependence, and the dose of naloxone.

The nurse should have resuscitation equipment readily available to support naloxone therapy, if it is needed. Other adjuncts that may be needed include oxygen, a mechanical ventilator, and emergency medications.

Diphenhydramine has several uses, including as an antihistamine, antitussive, antidyskinetic, and sedative/hypnotic. Instructions for use include taking the medication with food or milk to decrease gastrointestinal upset and to use oral rinses, sugarless gum, or hard candy to minimize dry mouth. Because the medication causes drowsiness, the client should avoid the use of alcohol or central nervous system depressants, operating a car, or engaging in other activities requiring mental acuity during use.

The addictive properties of diphenhydramine hydrochloride are enhanced when used with psychotropic medications.

A common side effect of INH is peripheral neuritis. This is manifested by numbness, tingling, and paresthesias in the extremities. This side effect can be minimized by pyridoxine (vitamin B6) intake.

INH is hepatotoxic, and therefore the client is taught to report signs and symptoms of hepatitis immediately (which include yellow skin and sclera). For the same reason, alcohol should be avoided during therapy. The client should avoid intake of Swiss cheese, fish such as tuna, and foods containing tyramine because they may cause a reaction characterized by redness and itching of the skin, flushing, sweating, tachycardia, headache, or lightheadedness. The client can avoid developing peripheral neuritis by increasing the intake of pyridoxine (vitamin B6) during the course of INH therapy.

INH therapy can cause an elevation of hepatic enzyme levels and hepatitis. Therefore, liver enzyme levels are monitored when therapy is initiated and during the first 3 months of therapy. They may be monitored longer in the client who is over age 50 or abuses alcohol.

Rifampin, an antibiotic, should be taken exactly as directed. Doses should not be doubled or skipped. The client should not stop therapy until directed to do so by a physician. The medication should be administered on an empty stomach unless it causes gastrointestinal upset, and then it may be taken with food. Antacids, if prescribed, should be taken at least 1 hour before the medication. Rifampin causes orange-red discoloration of body secretions and will permanently stain soft contact lenses.

Ethambutol, a bacteriostatic antimycobacterial, causes optic neuritis, which decreases visual acuity and the ability to discriminate between the colors red and green. This poses a potential safety hazard when a client is driving a motor vehicle. The client is taught to report this symptom immediately. The client is also taught to take the medication with food if GI upset occurs. Impaired hearing results from antitubercular therapy with streptomycin. Orange-red discoloration of secretions occurs with rifampin (Rifadin).

Cycloserine (Seromycin) is an antitubercular medication that requires weekly serum drug level determinations to monitor for the potential of neurotoxicity. Serum drug levels lower than 30 mg/mL reduce the incidence of neurotoxicity. The medication needs to be taken after meals to prevent gastrointestinal irritation. The client needs to be instructed to notify the physician if a skin rash or signs of central nervous system toxicity are noted. Alcohol needs to be avoided because it increases the risk of seizure activity.

Ecotrin is an aspirin-containing product and should be avoided. Excessive alcohol consumption should be avoided when taking warfarin sodium. Taking prescribed medication at the same time increases client compliance. The Medic-Alert bracelet provides health care personnel emergency information.

The PT will assess for the therapeutic effect of warfarin sodium (Coumadin) and the aPTT will assess the therapeutic effect of heparin sodium. The RBC and platelet counts will assess red blood cell concentration and the client's potential for bleeding, respectively. Warfarin sodium doses are determined based the results of the PT.

The therapeutic serum digoxin level ranges from 0.5 to 2 ng/mL.

Clients on potassium-wasting diuretics are at high risk of hypokalemia. Clinical manifestations of hypokalemia include fatigue, anorexia, nausea, vomiting, muscle weakness, leg cramps, decreased bowel motility, paresthesias, and dysrhythmias. Diarrhea and intestinal colic are signs of hyperkalemia. Tingling of the fingers and toes are signs of hypocalcemia.

Double vision, loss of appetite, and nausea are signs of digoxin toxicity. Additional signs of digoxin toxicity include bradycardia, visual alterations such as green and yellow vision, seeing spots or halos, confusion, vomiting, diarrhea, decreased libido, and impotence.

For subcutaneous heparin sodium injection, a 25- to 27-gauge, ⅝-inch needle is used to prevent tissue trauma and inadvertent intramuscular injection. A 1-inch needle would inject the heparin sodium into the muscle. The application of heat may affect the absorption of the heparin. Aspiration before injection is avoided with heparin sodium.

The PT will assess for the therapeutic effect of warfarin sodium (Coumadin) and the aPTT will assess the therapeutic effect of heparin sodium. Heparin sodium doses are determined based on these laboratory results. The hemoglobin and hematocrit values assess red blood cell concentrations.

Streptokinase, used to treat MI, converts plasminogen in the blood to plasmin. Plasmin is an enzyme that digests or dissolves fibrin clots wherever they exist.

Diltiazem is a calcium channel blockers that inhibits calcium influx through the slow channels of the membrane of smooth muscle cells. Calcium channel blockers decrease myocardial oxygen demands and blocks calcium channels, thereby decreasing the force of contraction of the ventricular tissue.

Audible expiratory wheezes may indicate a serious adverse reaction, bronchospasm. Beta blockers may induce this reaction particularly in clients with chronic obstructive pulmonary disease (COPD) or asthma. A normal decrease in blood pressure and heart rate is expected. Insomnia is a frequent mild side effect and should be monitored.

Most beta blockers may be administered with food or on an empty stomach but propranolol is best absorbed if taken with meals or directly after eating. Exercise will not prevent orthostatic hypotension. Hot showers and baths are not advised because of their vasodilating effect. The client needs to be instructed how to take his or her pulse rate and to notify the physician if the heart rate falls below 60 beats per minute.

Furosemide is a diuretic, the morning is the best time to take the medication so as not to interrupt sleep. Notification of the health care provider is appropriate if edema is noted in the hands, feet, or face, or if the client is short of breath. Sitting up slowly prevents postural hypotension. Tea and coffee are stimulants as well as mild diuretics. These are a poor choice for hydration. Taking the medication at the same time each day improves compliance.

Clients on potassium-wasting diuretics are at high risk of hypokalemia. Clinical manifestations of hypokalemia include fatigue, anorexia, nausea, vomiting, muscle weakness, leg cramps, decreased bowel motility, paresthesias, and dysrhythmias. Diarrhea and intestinal colic are signs of hyperkalemia. Tingling of the fingers and toes are signs of hypocalcemia.

Isosorbide mononitrate is an antianginal medication. Headache is a frequent side effect of isosorbide mononitrate and usually disappears during continued therapy. If a headache occurs during therapy, the client should be instructed to take the medication with food or meals. It is not necessary to contact the physician unless the headaches persist with therapy. It is not appropriate to instruct the client to discontinue therapy or adjust the dosages.

t-PA is a thrombolytic. Hemorrhage is a complication of any type of thrombolytic medication. The client should be monitored for bleeding. Monitoring for renal failure and the client's psychosocial status is important; however, they are not the priority. Heparin sodium is given following thrombolytic therapy, but the question is not asking for the associated medications following t-PA therapy.

To help prevent tolerance, clients need a 12-hour "no-nitrate" time. In addition to having a 12-hour no-nitrate time, the client must rotate the nitrate patch and wash his or her hands to prevent topical absorption through the fingers.

Triamterene is a potassium-sparing diuretic, which means that the client must avoid the intake of foods high in potassium.

Thiazide diuretics such as hydrochlorothiazide are sulfa-based medications, and a client with a sulfa allergy is at risk for an allergic reaction.

Nicotinic acid should be avoided because it may lead to liver abnormalities. All lipid-lowering medications can also cause liver abnormalities, so a combination of nicotinic acid and cholestyramine is to be avoided. Constipation and bloating are the two most common side effects. Both walking and the reduction of fats in the diet are therapeutic measures to reduce cholesterol and triglyceride levels.

Spironolactone is a potassium-sparing diuretic that promotes sodium excretion while conserving potassium.

Used to treat congestive heart failure, hypotension is a common side effect with this medication, and an increased risk exists in an older client.

Atorvastin is an antihyperlipidemic medication. It is contraindicated in pregnancy, lactation, liver disease, biliary cirrhosis or obstruction, and severe renal dysfunction, and in clients who are hypersensitive to the medication.

The usual guidelines for administering nitroglycerin tablets for chest pain is to administer one tablet every 5 minutes PRN for chest pain, for a total dose of three tablets. If the client does not obtain relief after taking a third dose of nitroglycerin, the physician is notified. Because the client is still complaining of chest pain, the nurse would administer a second nitroglycerin tablet. The nurse would assess the client's pain level and check the client's blood pressure before administering each nitroglycerin dose. There is no data in the question that indicates the need to call a code blue.

Used to treat UTI, cinobac is a urinary antiseptic and is administered with meals to decrease GI side effects.

Cinoxacin should be administered with caution in clients with renal impairment. The dosage should be reduced, and failure to do so could result in accumulation of cinoxacin to toxic levels. Therefore, the nurse would verify the prescription with the physician if the client had a documented history of renal insufficiency. The laboratory test result and diagnostic test result are normal findings. Folic acid (vitamin B6) may be prescribed for a client with renal insufficiency to prevent anemia.

NegGram is used for acute and chronic urinary tract infections, especially gram-negative bacterial infections. The medication is contraindicated in clients with a history of seizures. It is used with caution in clients with liver or renal disorders.

Nalidixic acid can intensify the effects of oral anticoagulants. When an oral anticoagulant is combined with nalidixic acid, a reduction in the anticoagulant dosage may be needed.

Used to treat gram-positive UTI, mandelamine is contraindicated in clients with renal or hepatic disease or clients with severe dehydration. The nurse would question the physician's prescription for this medication in the client with cirrhosis.

Gastrointestinal effects are the most frequent adverse reactions to this medication and can be minimized by administering the medication with milk or meals. Pulmonary reactions, manifested as dyspnea, chest pain, chills, fever, cough, and the presence of alveolar infiltrates on the x-ray, would indicate the need to stop the treatment. These symptoms resolve in 2 to 4 days following discontinuation of this medication.

Is a sulfonamide (sulfa drug). Each dose of sulfisoxazole should be administered with a full glass of water, and the client should maintain a high fluid intake. The medication is more soluble in alkaline urine. The client should not be instructed to taper or discontinue the dose. Some forms of sulfisoxazole cause the urine to turn dark brown or red. This does not indicate the need to notify the physician.

Clients taking trimethoprim-sulfamethoxazole should be informed about early signs of blood disorders that can occur from this medication. These signs include sore throat, fever, or pallor, and the client should be instructed to notify the physician if these symptoms occur. The other options do not require physician notification.

The client should be instructed that a reddish-orange discoloration of urine may occur. The client should also be instructed that this discoloration can stain fabric. The medication should be taken after meals to reduce the possibility of GI upset. A headache is an occasional side effect of the medication and does not warrant discontinuation of the medication.

Urecholine can be hazardous to clients with urinary tract obstruction or weakness of the bladder wall. The medication has the ability to contract the bladder and thereby increase pressure within the urinary tract. Elevation of pressure within the urinary tract could rupture the bladder in clients with these conditions

Administration of bethanechol with meals can cause nausea and vomiting in the client. To avoid this problem, oral doses should be administered 1 hour before meals or 2 hours after meals.

Cholinergic overdose can occur with bethanechol. The antidote is atropine sulfate administered subcutaneous or by the intravenous route, which should be readily available for use should overdose occur. Protamine sulfate is the antidote for heparin. Vitamin K is the antidote for Coumadin. Mucomyst is the antidote for acetaminophen (Tylenol) overdose.

Toxicity produces central nervous system excitation, such as nervousness, restlessness, hallucinations, and irritability. Other signs of toxicity include either hypotension or hypertension, confusion, tachycardia, flushed or red face, and signs of respiratory depression. Drowsiness is a frequent side effect of the medication, but does not indicate toxicity.

Used to treat bladder spasms, Pro-Banthine is contraindicated in clients with narrow angle glaucoma, obstructive uropathy, gastrointestinal disease or ulcerative colitis.

Prophylactic treatment post kidney transplant, Nephrotoxicity can occur from the use of Sandimmune. Nephrotoxicity is evaluated by monitoring for elevated BUN and serum creatinine levels. Sandimmune does not depress the bone marrow.

A compound present in grapefruit juice inhibits metabolism of cyclosporine. As a result, consuming grapefruit juice can raise cyclosporine levels by 50% to 100%, thereby greatly increasing the risk of toxicity.

To improve palatability, the client should be taught to mix the concentrated medication solution with chocolate milk or orange juice just before administration. Grapefruit juice can raise cyclosporine levels. Instruct the client to dispense the oral liquid into a glass container using a specially calibrated pipette; mix well and drink immediately; rinse the container with diluent and drink it to ensure ingestion of the complete dose; dry the outside of the pipette and return to its cover for storage.

The most common adverse effects of cyclosporine are nephrotoxicity, infection, hypertension, tremor, and hirsutism. Of these, nephrotoxicity and infection are the most serious.

Tacrolimus is used with caution in immunosuppressed clients and in clients with renal or hepatic function impairment. It is contraindicated in clients with hypersensitivity to this medication or hypersensitivity to cyclosporine.

Nephrotoxicity is a major concern with this medication. Other common reactions include neurotoxicity evidenced by headache, tremor, and insomnia, gastrointestinal effects (such a diarrhea, nausea, and vomiting), hypertension, hyperkalemia, and hyperglycemia.

Prophylaxis for organ rejection, Mycophenolate mofetil should be administered on an empty stomach. The capsules should not be opened or crushed. The client should contact the physician if unusual bleeding or bruising, sore throat, mouth sores, abdominal pain, or fever occurs. Antacids containing magnesium and aluminum may decrease the absorption of the medication and therefore should not be taken with the medication. The medication is given in combination with corticosteroids and cyclosporine.

Epoetin alfa is used to reverse anemia associated with CRF. A therapeutic effect is seen when the hematocrit is between 30% and 33%.

Epoetin alfa is generally well tolerated. The most significant adverse effect is hypertension. Occasionally, a tachycardia may occur as a side effect. It may also cause an improved sense of well-being.

Epoetin alfa stimulates erythropoiesis. Initial effects are noted within 1 to 2 weeks and hematocrit levels reach normal levels in 2 to 3 months. Therefore, this medication is not intended for clients who require immediate correction of severe anemia, and it is not a substitute for emergency transfusions.

The client should be instructed not to shake the medication bottle. The medication should be refrigerated but not frozen. Syringes with ⅝-inch needles are used to administer subcutaneous injections

The client who is receiving Amphojel should take the medication with meals. The phosphate-binding effect is best when it is taken with food. If tablets are used, they should be chewed well before swallowing.

Codeine sulfate is the narcotic analgesic often used for clients after craniotomy. It is frequently combined with a non-narcotic analgesic such as acetaminophen for added effect. It does not alter the respiratory rate or mask neurological signs as do other narcotics. Side effects of codeine include gastrointestinal upset and constipation. The medication can lead to physical and psychological dependence with chronic use. It is not the strongest narcotic analgesic available.

Myasthenia gravis can often be diagnosed based on clinical signs and symptoms. The diagnosis can be confirmed by injecting the client with a dose of Tensilon. This medication inhibits the breakdown of an enzyme in the neuromuscular junction, so more acetylcholine binds to receptors. If the muscle is strengthened for 3 to 5 minutes after this injection, it confirms a diagnosis of myasthenia gravis. Another medication, neostigmine (Prostigmin), may also be used because its effect lasts for 1 to 2 hours, providing a better analysis. For either medication, atropine sulfate should be available as the antidote.

Edrophonium (Tensilon) is a short-acting acetylcholinesterase inhibitor used as a diagnostic agent. When a client with suspected myasthenia gravis is given the medication intravenously, an increase in muscle strength would be seen in 1 to 3 minutes. If no response occurs, another dose of edrophonium (Tensilon) is given over the next 2 minutes and muscle strength is again tested. If no increase in muscle strength occurs with this higher dose, the muscle weakness is not caused by myasthenia gravis. Clients receiving injections of this medication commonly demonstrate a drop of blood pressure, feel faint and dizzy, and are flushed.

An edrophonium (Tensilon) injection makes the client in cholinergic crisis temporarily worse. This is known as a negative Tensilon test. An improvement of weakness would occur if the client were experiencing myasthenia gravis. Options 3 and 4 would not occur in either crisis.

Edrophonium (Tensilon) is administered to determine whether the client is reacting to an overdose of a medication (cholinergic crisis) or to an increasing severity of the disease (myasthenic crisis). When the edrophonium (Tensilon) injection is given and the condition improves temporarily, the client is in myasthenic crisis. This is known as a positive Tensilon test. Increasing weakness would occur in cholinergic crisis.

Edrophonium may be given to test for myasthenic crisis. If the client is in myasthenic crisis, muscle strength improves after administration of the medication and lasts for about 30 minutes.

Carbamazepine (Tegretol) is contraindicated in liver disease, and liver function tests are routinely prescribed for baseline purposes and are monitored during therapy. It is also contraindicated if the client has a history of blood dyscrasias.

In adults, overdose of acetaminophen (Tylenol) causes liver damage. Option 2 is an indicator of liver function, and is the only option that indicates an abnormal laboratory value. The normal direct bilirubin is 0 to 0.4 mg/dL. The normal platelet count is 150,000 to 400,000 cells/μl. The normal prothrombin time is 10 to 13 seconds. The normal sodium level is 135 to 145 mEq/L.

Side effects of baclofen (Lioresal) include drowsiness, dizziness, weakness, and nausea. Occasional side effects include headache, paresthesia of the hands and feet, constipation or diarrhea, anorexia, hypotension, confusion, and nasal congestion. Paradoxical central nervous system excitement and restlessness can occur, along with slurred speech, tremor, dry mouth, nocturia, and impotence.

Baclofen is a skeletal muscle relaxant and acts at the spinal cord level to decrease the frequency and amplitude of muscle spasms in clients with spinal cord injuries or diseases and in clients with multiple sclerosis.

Baclofen is a central nervous system (CNS) depressant and frequently causes drowsiness, dizziness, weakness, and fatigue. It can also cause nausea, constipation, and urinary retention. Clients should be warned about the possible reactions.

Baclofen is a central nervous system (CNS) depressant. The client should be cautioned against the use of alcohol and other CNS depressants, because baclofen potentiates the depressant activity of these agents. Constipation rather that diarrhea is a adverse effect of baclofen. It is not necessary to restrict fluids, but the client should be warned that urinary retention can occur. Fatigue is related to a CNS effect that is most intense during the early phase of therapy and diminishes with continued medication use. It is not necessary that the client notify the physician if fatigue occurs.

Baclofen is dispensed in 10- and 20-mg tablets of for oral use. Dosages are low initially and then gradually increased. Maintenance doses range from 15 to 20 mg administered three or four times a day.

The client should be instructed that symptoms such as drowsiness, weakness, and fatigue are more intense in the early phase of therapy and diminish with continued medication use. The client should be instructed never to withdraw or stop the medication abruptly, because abrupt withdrawal can cause visual hallucinations, paranoid ideation, and seizures. It is best for the nurse to inform the client that these symptoms will subside and encourage the client to continue the use of the medication.

Clients with seizure disorders may have a lowered seizure threshold when baclofen is administered. Concurrent therapy may require an increase in the anticonvulsive medication.

Baclofen is a centrally acting skeletal muscle relaxant. Side effects of baclofen (Lioresal) include drowsiness, dizziness, weakness, and nausea. Occasional side effects include headache, paresthesia of the hands and feet, constipation or diarrhea, anorexia, hypotension, confusion, and nasal congestion.

Baclofen is the only skeletal muscle relaxant that can be administered intrathecally within the spinal column.

Cholinergic crisis occurs as a result of an overdose of medication. Indications of cholinergic crisis includes gastrointestinal disturbances, nausea, vomiting, diarrhea, abdominal cramps, increased salivation and tearing, miosis, hypertension, sweating, and increased bronchial secretions.

The antidote for cholinergic crisis is atropine sulfate. Vitamin K is the antidote for warfarin (Coumadin). Protamine sulfate is the antidote for heparin, and acetylcysteine (Mucomyst) is the antidote for acetaminophen (Tylenol).

Dyskinesia and impaired voluntary movement may occur with high levodopa dosages. Nausea, anorexia, dizziness, orthostatic hypotension, bradycardia, and akinesia (the temporary muscle weakness that lasts 1 minute to 1 hour, also known as the "on-off phenomenon") are frequent side effects of the medication.

If levodopa is causing nausea and vomiting, the nurse would tell the client that taking the medication with food will prevent the nausea. Antiemetics from the phenothiazine class should not be used because they block the therapeutic action of dopamine. The other options are incorrect.

Phenytoin (Dilantin) it an anticonvulsant. Gingival hyperplasia, bleeding, swelling, and tenderness of the gums can occur with the use of this medication. The client needs to be taught good oral hygiene, gum massage, and the need for regular dentist visits. The client should not skip medication doses, because this could precipitate a seizure. Capsules should not be chewed or broken and they must be swallowed. The client needs to be instructed to report a sore throat, fever, glandular swelling, or any skin reaction, because this indicates hematological toxicity.

The therapeutic serum drug level range for phenytoin (Dilantin) is 10 to 20 mcg/mL.

Phenytoin (Dilantin) enhances the rate of estrogen metabolism, which can decrease the effectiveness of some birth control pills.

The therapeutic phenytoin (Dilantin) level is 10 to 20 mcg/mL. At a level higher than 20 mcg/mL, involuntary movements of the eyeballs (nystagmus) appears. At a level higher than 30 mcg/mL, ataxia and slurred speech occur.

Phenytoin sodium causes gum bleeding and hypertrophy, and therefore oral hygiene is important. Soft toothbrushes and gum massage should be instituted to reduce the risk of complications and prevent further trauma.

Ibuprofen (Motrin) is a nonsteroidal anti-inflammatory drug (NSAID). NSAIDs should be given with milk or food to prevent gastrointestinal irritation.

For acute or chronic rheumatoid arthritis or osteoarthritis, the normal oral adult dose for an older client is 300 to 800 mg three or four times daily.

Adverse effects of carbamazepine (Tegretol) appear as blood dyscrasias, including aplastic anemia, agranulocytosis, thrombocytopenia, leukopenia, cardiovascular disturbances, thrombophlebitis, dysrhythmias, and dermatological effects.

A centrally acting skeletal muscle relaxant, Incoordination and drowsiness are common side effects resulting from this medication.

Diazepam is a sedative-hypnotic with anticonvulsant and skeletal muscle relaxant properties. The nurse should institute safety measures before leaving the client's room to ensure that the client does not injure herself or himself. The most frequent side effects of this medication are dizziness, drowsiness, and lethargy. For this reason, the nurse puts the side rails up on the bed before leaving the room to prevent falls.

Diazepam is a centrally acting skeletal muscle relaxant. Incoordination and drowsiness are common side effects resulting from this medication. The other options are incorrect.

Morphine sulfate suppresses the cough reflex. Clients need to be encouraged to cough and deep breathe to prevent pneumonia.

Side effects of this medication include respiratory depression, orthostatic hypotension, tachycardia, drowsiness and mental clouding, constipation, and urinary retention.

Meperidine hydrochloride is a narcotic analgesic. Side effects include respiratory depression, hypotension, drowsiness, constipation, urinary retention, nausea, vomiting, and tremors.

While the client is taking codeine sulfate, the nurse would monitor vital signs and monitor for hypotension. The nurse should also increase fluid intake, palpate the bladder for urinary retention, auscultate bowel sounds, and monitor the pattern of daily bowel activity and stool consistency. The nurse should monitor respiratory status and initiate breathing and coughing exercises. Additionally, the nurse monitors the effectiveness of the pain medication.

Dantrolene can cause liver damage, and the nurse should monitor liver function studies. Baseline liver function studies are done before therapy starts, and regular liver function studies are performed throughout therapy. Dantrolene is discontinued if no relief of spasticity is achieved in 6 weeks.

Dantrium acts directly on skeletal muscle to relieve muscle spasticity. The primary action is the suppression of calcium release from the sarcoplasmic reticulum. This in turn decreases the ability of the skeletal muscle to contract.

Dose-related liver damage is the most serious adverse effect of dantrolene. To reduce the risk of liver damage, liver function tests should be performed before treatment and throughout the treatment course. It is administered in the lowest effective dosage for the shortest time necessary.

Dantrolene can cause liver damage, and the nurse should monitor the results of liver function studies. Baseline liver function studies are done before therapy starts, and regular liver function studies are performed throughout therapy. Dantrolene is discontinued if no relief of spasticity is achieved in 6 weeks. The other options are incorrect.

For treatment of spasticity, dantrolene is administered orally. The initial dose in adults is 25 mg once daily. The usual maintenance dosage is 100 mg 2 to 4 times daily. If beneficial effects do not develop within 45 days, dantrolene therapy should be discontinued.

Mannitol (Osmitrol) is an osmotic diuretic that induces diuresis by raising the osmotic pressure of glomerular filtrate, thereby inhibiting tubular reabsorption of water and solutes. It is used to reduce intracranial pressure in the client with head trauma.

Mild intoxication with acetylsalicylic acid (Aspirin) is called salicylism and is commonly experienced when the daily dosage is higher than 4 g. Tinnitus (ringing in the ears) is the most frequently occurring effect noted with intoxication. Hyperventilation may occur because salicylate stimulates the respiratory center. Fever may result because salicylate interferes with the metabolic pathways involved with oxygen consumption and heat production.

Aspirin may be used to treat client with rheumatoid arthritis. It may also be used to reduce the risk of recurrent transient ischemic attach (TIA) or stroke or reduce the risk of myocardial infarction (MI) in clients with unstable angina or a history of a previous MI. The normal dose for clients being treated with aspirin to decrease thrombosis and MI is 300 to 325 mg/day. Clients being treated to prevent TIAs are usually prescribed 1.3 g/day in two to four divided doses. Clients with rheumatoid arthritis are treated with 3.2 to 6 g/day in divided doses.

Colchicine is contraindicated in clients with severe gastrointestinal, renal, hepatic or cardiac disorders or blood dyscrasias. Clients with impaired renal function may exhibit myopathy and neuropathy manifested as generalized weakness. This medication should be used with caution in clients with impaired hepatic function, the older client, and the debilitated.

Benemid is a medication used for clients with gout to inhibit the reabsorption of uric acid by the kidney and promote excretion of uric acid in the urine. Uric acid is produced when purine is catabolized. Clients are instructed to modify their diet and limit excessive purine intake. High-purine foods to avoid or limit include organ meats, roe, sardines, scallops, anchovies, broth, mincemeat, herring, shrimp, mackerel, gravy, and yeast.

Benemid is a medication used for clients with gout to inhibit the reabsorption of uric acid by the kidney and promote excretion of uric acid in the urine. Uric acid is produced when purine is catabolized. Clients are instructed to modify their diet and limit excessive purine intake. High-purine foods to avoid or limit include organ meats, roe, sardines, scallops, anchovies, broth, mincemeat, herring, shrimp, mackerel, gravy, and yeast.

Dolobid may be given with water, milk, or meals. The tablets should not be crushed or broken open. Taking the medication with a large amount of water or milk should be tried before contacting the physician.

Because this medication has anticholinergic effects, it should be used with caution with clients with a history of urinary retention, angle-closure glaucoma, and increased intraocular pressure. Cyclobenzaprine hydrochloride should be used only for short-term 2- to 3-week therapy.

The client needs to be told that the urine may turn brown, black, or green. Other adverse effects include blurred vision, nasal congestion, urticaria, and rash. The client needs to be instructed that, if these adverse effects occur, the physician needs to be notified.

The normal adult dosage for carisoprodol is 350 mg orally three or four times daily.

Because therapeutic and toxic dosage ranges are so close, lithium blood levels must be monitored very closely, more frequently at first and then once every several months. The client should be instructed to contact the physician if excessive diarrhea, vomiting, or diaphoresis occurs. Lithium is irritating to the gastric mucosa; therefore, lithium should be taken with meals. A normal diet and normal salt and fluid intake (1500 to 3000 mL/day) should be maintained, because lithium decreases sodium reabsorption by the renal tubules, which could cause sodium depletion. A low sodium intake causes lithium retention and could lead to toxicity.

The therapeutic serum level of lithium ranges from 0.6 to 1.2 mEq/L. Serum lithium levels above the therapeutic level will produce signs of toxicity.

The client who is on lithium carbonate must be off the medication for 1 to 2 days before a scheduled surgical procedure and can resume the medication when full oral intake is ordered after the surgery.

The therapeutic serum level of lithium is 0.6 to 1.2 mEq/L. A level of 3 mEq/L indicates toxicity.

Lithium is the medication of choice to treat manic-depressive illness. Many over-the-counter (OTC) medications interact with lithium, and the client is instructed to avoid OTC medications while taking lithium. Lithium is not addicting and, although serum lithium levels need to be monitored, it is not necessary to check these levels every week. A tyramine-free diet is associated with monoamine oxidase inhibitors.

Psychotic disorder treatment, Toxic effects include extrapyramidal symptoms noted as marked drowsiness and lethargy, excessive salivation, and a fixed stare. Akathisia, acute dystonias, and tardive dyskinesia are also signs of toxicity. Hypotension, nausea, and blurred vision are occasional side effects.

Haloperidol acts by blocking the binding of dopamine to the post synaptic dopamine receptors in the brain.

Haloperidol is used to treat clients exhibiting psychotic features. Therefore, to determine medication effectiveness, the nurse would check the client's orientation and delusional status. Vital signs are routine and not specific to this situation. The physical safety of other clients is not a direct assessment of this client. Monitoring nutritional intake is not related to this situation.

Buspirone hydrochloride is used in the management of anxiety disorders. The advantages of this medication are that it is not sedating, tolerance does not develop, and it is not addicting. Dizziness, nausea, headaches, nervousness, lightheadedness, and excitement, which generally are not major problems, are side effects of the medication.

Buspirone hydrochloride is not recommended for the treatment of drug or alcohol withdrawal, paranoid thought disorders, or schizophrenia (thought broadcasting or delusions). Buspirone hydrochloride is most often indicated for the treatment of anxiety and aggression.

Bromocriptine is an antiparkinsonian prolactin inhibitor used in the treatment of neuroleptic malignant syndrome. Vitamin K is the antidote for warfarin (Coumadin) overdose. Protamine sulfate is the antidote for heparin overdose. Enalapril maleate is an antihypertensive used in the treatment of hypertension.

Hematological reactions can occur in the client taking clozapine and include agranulocytosis and mild leukopenia. The white blood cell count should be checked before initiating treatment and should be monitored closely during the use of this medication. The client should also be monitored for signs indicating agranulocytosis, which may include sore throat, malaise, and fever.

Disulfiram is used as an adjunct treatment for selective clients with chronic alcoholism who want to remain in a state of enforced sobriety. Clients must abstain from alcohol intake for at least 12 hours before the initial dose of the medication is administered. The most important data is to determine when the last alcoholic drink was consumed. The medication is used with caution in clients with diabetes mellitus, hypothyroidism, epilepsy, cerebral damage, nephritis, and hepatic disease. It is also contraindicated in severe heart disease, psychosis, or hypersensitivity related to the medication.

Donepezil hydrochloride is a cholinergic agent used in the treatment of mild to moderate dementia of the Alzheimer type. It enhances cholinergic functions by increasing the concentration of acetylcholine. It slows the progression of Alzheimer's disease.

Donepezil hydrochloride (Aricept) inhibits the breakdown of released acetylcholine

Fluoxetine hydrochloride is administered in the early morning without consideration to meals.

Fluoxetine hydrochloride (Prozac) is a potent serotonin reuptake blocker.

The most common adverse effects related to fluoxetine include central nervous system (CNS) and gastrointestinal (GI) system dysfunction. This medication affects the GI system by causing nausea and vomiting, cramping, and diarrhea.

Imipramine hydrochloride (Tofranil) blocks the reuptake of norepinephrine and serotonin.

The therapeutic effects of administration of imipramine hydrochloride (Tofranil) may not occur for 2 to 3 weeks after the antidepressant therapy has been initiated.

Thioridazine can cause postural hypotension. The client needs to be taught to get out of bed slowly and to rise from a sitting position slowly because of this adverse effect related to the medication.

Chloral hydrate causes sedation and impairment of motor coordination; therefore, safety measures need to be implemented. The client is instructed to call for assistance with ambulation.

Clomipramine is commonly used in the treatment of obsessive-compulsive disorder. Hand washing is a common obsessive-compulsive behavior. Weight gain is a common side effect of this medication. Tachycardia and sedation are side effects. Insomnia may occur as a seldom side effect.

Bupropion does not cause significant orthostatic blood pressure changes. Seizure activity is common in dosages greater than 450 mg daily. Bupropion frequently causes a drop in body weight. Insomnia is a side effect but seizure activity causes a greater client risk.

Phenelzine sulfate is a monoamine oxidase inhibitor (MAOI). The client should avoid taking in foods that are high in tyramine. These foods could trigger a potentially fatal hypertensive crisis. Foods to avoid include yogurt, aged cheeses, smoked or processed meats, red wines, and fruits such as avocados, raisins, or figs.

Phenobarbital sodium is an anticonvulsant and a hypnotic agent. The client should avoid taking any other central nervous system depressants (such as alcohol) while taking this medication. The medication may be given without regard to meals. Taking the medication at the same time each day enhances compliance and maintains more stable blood levels of the medication. Using a dose container or "pillbox" may be helpful for some clients.

Dry mouth is a common side effect of this medication. Frequent mouth rinsing with water, sucking on hard candy, and chewing gum will alleviate this common side effect. Hypotension and hypertension are rare side effects of fluphenazine. Leukopenia is common but not viewed as a serious health threat, and the WBC count would not be obtained on a daily basis. Weight gain is a common side effect and frequent snacks will aggravate this problem.

Tranylcypromine sulfate is a monoamine oxidase inhibitor (MAOI) used to treat depression. A tyramine-restricted diet is required while on this medication to avoid hypertensive crisis, a life-threatening side effect of the medication. Foods to be avoided are meats prepared with tenderizer, smoked or pickled fish, beef or chicken liver, and dry sausage (salami, pepperoni, bologna). In addition, figs, bananas, aged cheese, yogurt, sour cream, beer, red wine, alcoholic beverages, soy sauce, yeast extract, chocolate, caffeine, and aged, pickled, fermented, or smoked foods need to be avoided. Many over-the-counter medications also contain tyramine and must be avoided as well.

Amitriptyline hydrochloride is a tricyclic antidepressant often used to treat depression. It causes orthostatic changes and can produce hypotension and tachycardia. This can be frightening to the client and dangerous, because it could result in dizziness and client falls. The client must be instructed to move slowly from a lying to a sitting to a standing position to avoid injury if these effects are experienced. The client may also experience sedation, dry mouth, constipation, blurred vision, and other anticholinergic effects, but these are transient and will diminish with time.

When carbamazepine is administered, blood levels need to be drawn periodically to check for the child's absorption of the medication. The amount of the medication prescribed is based on the blood level achieved. The therapeutic serum level for this medication is 4 to 12 mcg/mL.

Carbamazepine is an anticonvulsant that should be taken around the clock, precisely as directed. If a dose is omitted, the client should take the dose as soon as it is remembered, as long as it is not immediately before the next dose. The medication should not be double dosed. If more than one dose is omitted, the client should call the physician.

Carbamazepine acts by depressing synaptic transmission in the central nervous system (CNS). Because of this, the client should avoid driving or doing other activities that require mental alertness until the effect on the client is known. The client should use protective clothing and sunscreen to avoid photosensitivity reactions. The medication may cause dry mouth (not excessive salivation), and the client should be instructed to provide good oral hygiene, and use sugarless candy or gum as needed. The medication should not be abruptly discontinued, because it could cause return of seizures or status epilepticus. Fever and sore throat should be reported to the physician (leukopenia).

Diclofenac is a nonsteroidal antiinflammatory (NSAID) drug. Interactions may occur with anticoagulants. The nurse should consult with the physician regarding a potential medication interaction. Mesoridazine besylate is an antipsychotic medication. Primidone is an anticonvulsant, and trifluoperazine hydrochloride is an antipsychotic. These medications are not contraindicated when administering diclofenac.

Common GI side effects of benztropine therapy include constipation and dry mouth. Other GI side effects include nausea and ileus. These effects are the result of the anticholinergic properties of the medication.

Clorazepate is classified as an anticonvulsant, antianxiety agent, and sedative/hypnotic (benzodiazepine). One of the nursing implications of clorazepate therapy is that the medication can lead to physical or psychological dependence when there is prolonged therapy at high doses. For this reason, the amount of medication that is readily available to the client at any one time is restricted.

Drowsiness, unsteadiness, and clumsiness are expected effects of the medication during early therapy. They are dose related, and usually diminish or disappear altogether with continued use of the medication. It does not indicate that a severe side effect is occurring. It is also unrelated to interaction with another medication. The client is encouraged to take this medication with food to minimize gastrointestinal upset.

Clonazepam is a benzodiazepine that is used as an anticonvulsant. During initial therapy and during periods of dosage adjustment, the nurse should initiate seizure precautions for the client.

Valproic acid is an anticonvulsant, antimanic, and antimigraine medication. It may be administered with or without food. It should not be taken with an antacid or carbonated beverage because these products will affect medication absorption. The medication is administered at the same time each day to maintain therapeutic serum levels.

Ergotamine produces vasoconstriction, which suppresses vascular headaches when given at a therapeutic dose range. The nurse monitors for hypertension, cool, numb fingers and toes, muscle pain, and nausea and vomiting.

Dextroamphetamine is a central nervous system (CNS) stimulant, which acts by releasing norepinephrine from nerve endings. The client should take the medication at least 6 hours before going to bed at night to prevent disturbances with sleep.

Dextroamphetamine is a central nervous system (CNS) stimulant. Caffeine is a stimulant also, and should be limited in the client taking this medication. The client should be taught to limit their own caffeine intake as well.

Signs and symptoms of Parkinson's disease usually begin to resolve within 2 to 3 weeks of starting therapy, although in some clients marked improvement may not be seen for up to 6 months. Clients need to understand this concept to aid in compliance with medication therapy.