Pharmacology in Nursing Practice

Yes, it is spelled correctly - SAMe.  It is not an herbal product or a drug, but a dietary supplement.  This supplement is a synthetic version of a coenzyme that occurs naturally (S-adenosymethionine).  This coenzyme is produced in the liver from essential amino acids, and is required for neurotransmitter production, such as serotonin and dopamine, which are usually deficient in depression. 

 SAMe has other functions besides helping depression, including enhancing cartilage repair and treating osteoarthritis. 

Patients who take SAMe are encouraged to take it on an empty stomach in the morning (as it energizes).  It is a capsule or an enteric-coated tablet, which is available for about $35 per month. 

 MAJOR WORD OF CAUTION REGARDING DRUG INTERACTIONS:

When caring for patients taking SAMe, inquire about other medications taken daily, as antidepressants that increase serotonin can cause sertonin syndrome, a potentially fatal condition.  You will find out about serotonin syndrome in the psychiatric drugs module/lecture.  Other drugs, such as Demerol (meperidine) or Ultram also can boost the level of serotonin, leading to the deadly syndrome. 

If you would like to ask the peer mentors a question or clarify content, please do so by posting a comment. 

  Which statement by a patient taking Celebrex (a COX-2 inhibitor) chronically indicates to the nurse the need for further teaching?

a.  “This medicine can cause bleeding in my stomach.”

b.  “The drug is ordered to decrease my pain.”

c.  “This medication will protect me from heart attacks.”

d.  “The longer I take this the higher the risk for kidney problems”

The nurse recognizes that the primary adverse effect of the biphosphonate alendronate (Fosamax) is:

a.  constipation

b.  esophagitis

c.  bone fracture

d.  hypertension

The nurse understands that ________ poses the greatest risk for thromboembolic phenomena in a patient taking oral contraceptives

a.  increased intake of saturated fatty acids in the diet

b.  sedentary life style

c.  obesity

d.  nicotine addiction

What medication would the nurse administer for a patient with adrenal insufficiency?

a.  spironolactone (Aldactone)

b.  potassium chloride

c.  epinephrine

d.  hydrocortisone

The nurse recognizes ___________ as the standard treatment for hypothyroidism.

 a.  antithyroid drugs

b.  radioactive iodine treatments

c.  surgery

d.  levothyroxine

A patient calls the office nurse complaining of chills and fever of 102 degrees. The patient also reports to be taking Tapazole (methimazole), an antithyroid medication. Based on this information, what is the most appropriate action for the nurse?

 a.  Ask the patient to come to the office for a complete blood cell count (CBC) today

b.  tell the patient to drink increased amounts of fluids to flush out the viral infection.

c.  ask the patient to stop the medication and return to the clinic in 2 days for a TSH level.

d.  ask the to continue the medication, but to  come to the clinic in the morning for evaluation.

A 39-year-old male, status post left knee replacement, is receiving Demerol (meperidine) by patient controlled analgesia pump. You suspect after 4 days of Demerol, he is becoming normeperidine toxic. Which of the following indicates normeperidine toxicity?

 a.  itching

b.  hypotensionh

c.  tremors

d.  chills and fever

You are ordered to administer intravenous glucocorticoid therapy to a patient with lupus. Of the following, which would be most appropriate for the nurse to do first?

 a.  Teach the patient about the drug

b.  check serum potassium level

c.  check serum sodium level

d.  ask the patient to rate their pain on a 0-10 scale