NGR 6172 PHARMACOLOGY MIDTERM EXAM WITH WELL ELABORATED DETAILED ANSWERS (GUARANTEED DISTINCTION)

NGR 6172 PHARMACOLOGY MIDTERM EXAM WITH WELL ELABORATED DETAILED ANSWERS (GUARANTEED DISTINCTION) 1). A pregnant patient asks the nurse if she can take antihistamines for seasonal allergies during her pregnancy. What will the nurse tell the patient? a. Antihistamines should be avoided unless absolutely necessary. b. Second-generation antihistamines are safer than first-generation antihistamines. c. Antihistamines should not be taken during pregnancy but may be taken when breast-feeding. d. The margin of safety for antihistamines is clearly understood for pregnant patients. A EXPLANATION Antihistamines are pregnancy Category C, with debate currently occurring regarding degree of effects on the fetus. They should be avoided unless absolutely necessary. All antihistamines have adverse effects on the fetus. Antihistamines can be excreted in breast milk. The margin of safety of antihistamines in pregnancy is not clear, so these agents should be avoided unless a clear benefit of treatment outweighs any risks 2)A 5-year-old child with seasonal allergies has been taking 2.5 mL of cetirizine [Zyrtec] syrup once daily. The parents tell the nurse that the child does not like the syrup, and they do not think that the drug is effective. The nurse will suggest they discuss which drug with their child's healthcare provider? a. Cetirizine [Zyrtec] 5-mg chewable tablet once daily b. Loratadine [Claritin] 10-mg chewable tablet once daily c. Fexofenadine [Allegra] syrup 5 mL twice daily d. Desloratadine [Clarinex] 5-mg rapid-disintegrating tablet once daily A EXPLANATION The child is receiving a low dose of cetirizine and can receive up to 5 mg per day in either a single dose or two divided doses. Cetirizine is available in a chewable tablet, which this child may tolerate better, so the parents should be encouraged to explore this option with their provider. The loratadine 10-mg chewable tablet is approved for children 6 years and older. Fexofenadine would be safe for this child, but it is unlikely that the syrup would be any better than the cetirizine syrup. Desloratadine is not approved for children under the age of 12 years. 3). A patient who takes daily doses of aspirin is scheduled for surgery next week. The nurse should advise the patient to: a. continue to use aspirin as scheduled. b. reduce the aspirin dosage by half until after surgery. c. stop using aspirin immediately. d. stop using aspirin 3 days before surgery. C EXPLANATION Aspirin must be withdrawn at least 1 week before surgery. Aspirin cannot be continued as scheduled, because the risk for bleeding is too great. An interval of 3 days is not long enough for the bleeding effects of aspirin to be reversed. Cutting the dose in half would not reduce the effects of bleeding associated with aspirin use. 4). A patient who takes aspirin for rheumatoid arthritis is admitted to the hospital complaining of headache and ringing in the ears. The plasma salicylate level is 300 mcg/mL, and the urine pH is 6.0. What will the nurse do? a. Increase the aspirin dose to treat the patient's headache. b. Notify the provider of possible renal toxicity. c. Prepare to provide respiratory support, because the patient shows signs of overdose. d. Withhold the aspirin until the patient's symptoms have subsided. D EXPLANATION This patient shows signs of salicylism, which occurs when ASA levels climb just slightly above the therapeutic level. Salicylism is characterized by tinnitus, sweating, headache, and dizziness. Tinnitus is an indication that the maximum acceptable dose has been achieved. Toxicity occurs at a salicylate level of 400 mcg/mL or higher. ASA should be withheld until the symptoms subside and then should be resumed at a lower dose. Increasing the dose would only increase the risk of toxicity. Signs of renal impairment include oliguria and weight gain, which are not present in this patient. This patient has salicylism, not salicylate toxicity, so respiratory support measures are not indicated.