Pharmacology > EXAM > NR 293 Week 6 Quiz 4 (GRADED A) Questions and Answer elaborations | 100% Correct solutions (All)

NR 293 Week 6 Quiz 4 (GRADED A) Questions and Answer elaborations | 100% Correct solutions

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NR293 Pharmacology Pre-class Questions Week 6 Answer the following questions. Give rationales for each question asked and include the reference and page number where the answer was found. Rationales... must be TYPED with chapter and pg. no. included. Upload test questions and rationales to the submission tab under the course shell. The assignment must be completed on the provided document. No other forms will be accepted. Questions will be graded for accuracy. Each question along with the rationale will be worth 0.5 points, for a total of 20 points possible. The assignment is due Sunday 02/16/20 at 11:59 pm. No late submissions will be accepted. Late submissions will result in zero points for the assignment. 1. What are possible effects of drugs for treating growth hormone deficiency in children? c. Retention of potassium levels d. Increased retention of sodium e. Improved tissue-building processes Rationale: “The drugs that mimic growth hormone (GH) are somatropin and somatrem. These drugs promote growth by stimulating various anabolic (tissue-building) processes, liver glycogenolysis (to raise blood sugar levels), lipid mobilization from body fat stores, and retention of sodium, potassium, and phosphorus. Both drugs promote linear growth in children who lack normal amounts of the endogenous hormone” Chapter 30, page 475 2. What assessment finding indicates to the nurse that vasopressin has been effective? a. Relief of pain b. Increased urine specific gravity c. Increased serum albumin levels d. Decreased adrenocorticotropic hormone levels Rationale: “The drugs that affect the posterior pituitary gland, such as vasopressin and desmopressin, mimic the actions of the naturally occurring antidiuretic hormone (ADH). They increase water resorption in the distal tubules and collecting ducts of the nephrons, and they concentrate urine, reducing water excretion by up to 90%” Chapter 30, page 475 3. The nurse is caring for a patient who has vasodilatory shock. On further assessment, the nurse finds that the patient has persisting orthostatic hypotension even after the medication is administered. What reason does the nurse expect for the persistence? a. The patient is administered vasopressin and carbamazepine. b. The patient is administered somatropin and glucocorticoids. c. The patient is administered vasopressin and demeclocycline. d. The patient is administered desmopressin and carbamazepine. Rationale: “An improvement in diabetes insipidus, esophageal varices, or vasodilatory shock is expected with vasopressin” Under Table 30.5 Pituitary Drugs: Selected Drug Interactions “Vasopressin—interacting drug: demeclocycline—having a potential results of reduced antidiuretic effect” “Demeclocycline (Declomycin) is a naturally occurring tetracycline antibiotic that is derived from strains of Streptomyces. It is used both for its antibacterial action and for its ability to inhibit the action of antidiuretic hormone in SIADH” Chapter 30, page 476 4. A patient is prescribed somatropin injection subcutaneously. Which nursing intervention promotes safe administration of the drug? a. Rotating the injection site b. Shaking the vial vigorously c. Administering in the ventral gluteal site d. Administering if the drug in the vial is cloudy Rationale: “For desmopressin and somatropin, rotate subcutaneous and/or IM injection sites” Chapter 30, page 478 5. The nurse is teaching a patient who is prescribed desmopressin and who has polyuria, polydipsia, and dehydration. Which statement by the patient indicates the need for additional teaching? a. "I will avoid taking demeclocycline." b. "I will avoid consuming alcohol along with the drug." c. "I will increase intake of juices and water in my diet." d. "I will take medicines immediately upon getting up in the morning." Rationale: “Desmopressin is also used for management of nocturnal enuresis” Chapter 30, page 475 6. The nurse instructs a nursing student to administer vasopressin to a patient. The student observes visible particles in the vasopressin solution and notifies the nurse. What instruction will the nurse give the student to ensure safe administration of vasopressin? a. "Heat the medicine before administration." b. "Do not administer the drug to the patient." c. "Shake the medication before administration." d. "Keep the bottle in warm water before administration." Rationale: “Vasopressin is available as a nasal spray or as an IM or IV injection. Always check the clarity of parenteral solutions before administering the medication. Discard the solution if there are visible particles or any fluid discoloration” Chapter 30, page 478 7. The nurse is caring for a patient who is receiving levothyroxine. The patient asks when the symptoms of hypothyroidism will stop. What is the nurse's best answer? a. "The medication will be effective in a couple of days." b. "It can take 1 to 4 weeks before the medication is effective." c. "You will need to be patient, because this medication takes 2 months to start working." d. "This is long-term therapy, and it will take at least 6 weeks before the medication is effective." Rationale: “These medications are not to be abruptly discontinued and lifelong therapy is generally the norm” “Advise the patient that it may take several weeks to see the full therapeutic effects of thyroid drugs” Chapter 31, page 487 8. The nurse prepares to administer an initial dose of propylthiouracil to a patient with toxic nodular disease of the thyroid gland. What baseline patient assessment is a priority for the nurse before the start of therapy? a. Skin condition b. Leukocyte count c. Size of the thyroid d. Coloration of the urine Rationale: “For antithyroid drugs, such as PTU and methimazole, assess vital signs as well as signs and symptoms of thyroid crisis or what is often called thyroid storm…Assess for precipitating causes of thyroid storm including stress or infection…Cautions and contraindications to reemphasize include interactions with oral anticoagulants resulting in risk for bleeding and any medication that results in bone marrow suppression or causes leucopenia. Antithyroid drugs may cause additive effects or worsening of bone marrow suppression” “A therapeutic response to antithyroid medications includes a return to normal status with little to no evidence of hyperthyroid. Adverse effects include the possibility of leucopenia, which may be manifested by fever, sore throat, lesions, or other signs of infection” Chapter 31, page 485 9. A patient who is taking propylthiouracil complains, "It's been 10 days since I started taking the medication, but my hunger is still not suppressed." What advice will the nurse provide? a. "Increase the amount of fiber in your diet." b. "Your hunger will subside in another 10 days." c. "Take the drug on an empty stomach before breakfast." d. "Make an appointment with your primary health care provider." Rationale: “PTU is a thioamide antithyroid drug and is classified as a pregnancy category D drug. Approximately 2 weeks of therapy with PTU may be necessary before symptoms improve” Chapter 31, page 485 10. The nurse is caring for a patient who has hyperthyroidism. The primary health care provider has prescribed methimazole. Which is the first and most important nursing action in this situation? a. Assess the patient's urine output. b. Assess signs of cardiac irregularities. c. Assess the patient's serum creatinine levels. d. Assess signs and symptoms of thyroid storm. Rationale: “For antithyroid drugs, such as PTU and methimazole, assess vital signs as well as signs and symptoms of thyroid crisis or what is often called thyroid storm. Thyroid storm is manifested by exacerbation of hyperthyroidism symptoms (see the pharmacology discussion) and is potentially life threatening. Chapter 31, page 485 11. The nurse is assessing a patient who has been taking propylthiouracil for the past 2 weeks and has normal thyroid-stimulating hormone (TSH) levels. For what symptom will the nurse primarily monitor the patient? a. Loss of appetite b. Cold intolerance c. Heart palpitations d. Unexplained weight gain Rationale: “Educate the patient taking the antithyroid drug PTU about dosing the medication with meals to help decrease stomach upset…Advise patients to be aware of the signs and symptoms of hypothyroidism, including unexplained weight gain, loss of mental and physical stamina, hair loss, firm edema, and yellow dullness of the skin (indicative of myxedema or a decrease in metabolic rate). If these occur, patients must immediately report them to the prescriber” Chapter 31, page 486 12. During an assessment, a patient asks the nurse, "What should I do if I miss two or three doses of thyroid replacement drug in a row?" What is the best response given by the nurse? a. "You can take the dose immediately when you remember it." b. "Skip the missed dose and resume your usual dosage schedule." c. "You should consult your primary health care provider immediately." d. "If it is almost time for your next dose; at that time take a double dose of drug." Rationale: “When a thyroid replacement drug is administered, it is important that the drug be given at the same time every day to help maintain consistent blood levels of the drug. Emphasize that it is best to take this medication once daily, as prescribed. It is extremely important to take thyroid replacement medication in the morning and on an empty stomach, preferably at least 30 minutes before breakfast. Taking the medication in the afternoon/evening will lead to a subsequent increase in energy level and sleeplessness” “Its half-life is long enough that it only needs to be administered once a day” “Oral levothyroxine should be taken consistently every morning 30-60 min before food” Although one could possibly take a dose immediately once they remember missing their dose, however, it’s not recommended to take this medication unless on an empty stomach to promote adequate absorption of the medication. Also, missing 2 to 3 doses of the medication could throw off the medication’s therapeutic range, hence the safety consideration of calling the primary health care provider for further instruction. Chapter 31, page 475 13. Which technique is most appropriate regarding mixing insulin when the patient must administer 30 units regular insulin and 70 units NPH insulin in the morning? a. Use the Z-track method for administration. b. Draw the medication into two separate syringes but inject it into the same spot. c. Draw up the regular insulin into the syringe first, followed by the cloudy NPH insulin. d. Administer these insulins at least 10 minutes apart so that you will know when they are working. Rationale: “When insulins are mixed (if ordered), withdraw the regular or rapid-acting insulin (unmodified and clear) first, followed by withdrawing the intermediate-acting or NPH insulin (modified and cloudy)” Chapter 32, page 507 14. A patient newly diagnosed with type 2 diabetes mellitus has been ordered insulin glargine. What information is essential for the nurse to teach this patient? a. "This medication has a duration of action of 24 hours." b. "This medication should be mixed with the regular insulin each morning." c. "This medication is very short-acting. You must be sure you eat after injecting it." d. "This medication is very expensive, but you will be receiving it only a short time." Rationale: “Insulin glargine is normally a clear, colorless solution with a pH of 4.0. Once it is injected into subcutaneous tissue at physiologic pH, it forms microprecipitates that are slowly absorbed over the next 24 hours” Chapter 32, page 497 15. A patient with type 1 diabetes mellitus has been ordered insulin aspart 10 units at 7:00 AM. What nursing intervention will the nurse perform after administering this medication? a. Flush the IV. b. Perform a fingerstick blood sugar test. c. Have the patient void and dipstick the urine. d. Make sure the patient eats breakfast immediately. Rationale: “It is important to know that the rapid-acting insulins (insulin lispro, insulin aspart, and insulin glulisine) have an onset of action of about 15 minutes and must be given at least 15 minutes before meals, compared with 30 minutes before meals for regular insulin or a short- acting insulin, which has an onset of action of 30 to 60 minutes” Chapter 32, page 508 16. What will the nurse teach a patient who takes metformin for type 2 diabetes? a. "You should take the medication with food." b. "You should report any nausea immediately." c. "If you miss a meal, you should skip the dose." d. "You have an increased risk of lactic acidosis." Rationale: “These effects are all usually self-limiting and can be lessened by starting with low dosages, titrating up slowly, and taking the medication with food” Chapter 32, page 499 17. The nurse would include which statement when teaching a patient about insulin glargine? a. "You can mix this insulin with NPH insulin to enhance its effects." b. "You cannot mix this insulin with any other insulin in the same syringe." c. "You should inject this insulin just before meals because it is very fast-acting." d. "The duration of action for this insulin is approximately 8 to 10 hours, so you will need to take it twice a day." Rationale: Under Table 32.4 “Insulin Mixing Compatibilities” “Insulin glargine (Lantus)— compatible with: Must be given alone due to low pH of dilutent” Chapter 32, page 494 18. The nurse administers NPH insulin at 8:00 AM. What intervention is essential for the nurse to perform? a. Monitor fingerstick at 2:00 PM. b. Make sure patient eats by 5:00 PM. c. Administer the insulin via IV pump. d. Assess the patient for hyperglycemia by 10:00 AM. Rationale: “The intermediate-acting insulin (NPH) has an onset of action of 1 to 2 hours, so serve meals at least 30 to 45 minutes prior to its administration” “When this insulin regimen is used, measure blood glucose levels several times per day (e.g., every 4 hours, every 6 hours, or at specified times such as 7 a.m., 11 a.m., 4 p.m., and midnight) to obtain fasting and/or premeal blood glucose values” Chapter 32, page 508 19. A patient with a history of asthma frequently receives prednisone for acute bronchitis. Which adverse effects should the nurse anticipate that the patient may experience with continuous use of the therapy? Select all that apply. a. Weight gain b. Hypoglycemia c. Increased sleep Rationale: Under Table 33.4 “Corticosteroids: Common Adverse Effects”: Body systems with adverse effects as follows; Central nervous—convulsions, headache, vertigo, mood swings, psychic impairment, nervousness, insomnia; Musculoskeletal—muscle weakness, loss of muscle mass, osteoporosis; Other—weight gain. Chapter 33, page 517 20. A patient who has been receiving long-term corticosteroid therapy has undergone surgery for the treatment of an abdominal hernia. Which potential effect of this therapy should the nurse expect to have the most impact on the patient’s recovery? a. Hypotension b. Osteoporosis c. Muscle weakness d. Delayed wound healing Rationale: Under Table 33.4 “Corticosteroids: Common Adverse Effects”: Body systems with adverse effects as follows; Integumentary—fragile skin, petechiae, ecchymosis, facial erythema, poor wound healing, hirsutism, urticaria. Chapter 33, page 517 21. A patient is about to receive steroid therapy. For what symptom should the nurse assess the patient? a. Septic shock b. Rheumatoid arthritis c. Uncontrolled diabetes mellitus d. Chronic obstructive pulmonary disease Rationale: “The glucocorticoids also promote the breakdown (catabolism) of protein, the production of glycogen in the liver (glycogenesis), and the redistribution of fat from peripheral to central areas of the body. In addition, they have the following effects on various bodily functions: increasing levels of blood sugar, increasing the breakdown of proteins to amino acids, inducing lipolysis, stimulating bone demineralization, and stabilizing mast cells” “Corticosteroids can reduce the hypoglycemic effects of antidiabetic drugs and can result in elevated blood glucose levels” chapter 33, page 517 (Lilley, Collins, & Snyder, 2020, Ch. 33, pg. 517). 22. The nurse teaches a patient receiving long-term corticosteroid drug therapy about the dosage regimen. Which response by the patient indicates the need for further teaching? a. "I will take this medication with food or milk regularly." b. "I will not touch or interact with people who have infections." c. "I will stop taking this medication if I have any adverse effects." d. "I will report to you immediately if I have fever or a sore throat." Rationale: “One very important point about the long-term use of steroids is that they must not be stopped abruptly. These drugs require a tapering of the daily dose, because the administration of these drugs causes the endogenous (body’s own) production of the hormones to stop” Chapter 33, page 518 23. The nurse is caring for a patient who has hypertension and is on continuous corticosteroid therapy to treat adrenal insufficiency. The electrocardiograph shows a steady slowing of the patient’s heart beat. The patient’s blood pressure is 140/96 mm Hg. Which drug is the nurse most likely to find while reviewing the patient’s medication history? a. Hydantoins b. Barbiturates c. Cholinergics d. Loop diuretic Rationale: “A therapeutic response to glucocorticoids includes a resolution of the underlying manifestations of the disease or pathology, such as a decrease in inflammation, an increased feeling of well-being, less pain and discomfort in the joints, a decrease in lymphocytes, or other improvement in the condition for which the medication was ordered. Adverse effects include weight gain; increased blood pressure; sodium increase and potassium loss; mental status changes such as mood swings, psychic impairment, and nervousness; abdominal distension; ulcer-related symptoms; and changes in vision” Under Table 33.4 “Corticosteroids: Common Adverse Effects”: Body systems with adverse effects as follows; Cardiovascular—heart failure, edema, hypertension—all due to electrolyte imbalances (e.g. hypokalemia, hypernatremia) Chapter 33, page 517 24. A patient is prescribed an aluminum-containing antacid for hyperacidity. The nurse should inform the patient about which possible adverse effect? a. Diarrhea b. Flatulence c. Constipation d. Muscle twitching Rationale: “The adverse effects of the antacids are limited. The magnesium preparations, especially milk of magnesia, can cause diarrhea. Both the aluminum-and calcium-containing formulations can result in constipation” Chapter 50, page 785 25. A patient with hyperacidity who was prescribed an aluminum-containing antacid reports constipation, headache, and dry mouth. On assessment, the nurse finds that the patient has high blood pressure. What can the nurse interpret from these symptoms? a. The patient has renal failure. b. The patient has a gastric tumor. c. The patient has hypercalcemia. d. The patient has thrombocytopenia. Rationale: “Chronic use of high-dose calcium-containing antacids or use in renal failure can cause a syndrome known as milk-alkali syndrome, which is characterized by headache, nausea, alkalosis, and hypercalcemia” Chapter 50, page 785 26. A patient has been taking aluminum hydroxide to treat gastric hyperacidity for a few days. The patient reports being constipated. Which drug will the provider order in addition to aluminum hydroxide? a. Sodium citrate b. Magnesium hydroxide c. Aluminum carbonate d. Calcium carbonate Rationale: “Magnesium-containing antacids commonly have a laxative effect, and frequent administration of these antacids alone often cannot be tolerated” Chapter 50, page 787 27. The primary health care provider prescribes a rapid-release form of famotidine to be given intravenously. What will the nurse monitor in the patient while administering the drug? a. If the patient has eaten b. If the patient has swallowed the drug c. If the patient has alterations in cognition d. If there are alterations in the patient’s blood pressure Rationale: “Dilute intravenous forms of famotidine or ranitidine with appropriate solutions, and infuse over the documented time frame. With intravenous H2 receptor antagonists, hypotension may occur with rapid infusion, so careful monitoring is critical to patient safety. Refer to appropriate sources for information on other specific drugs and their intravenous administration. For all H2 receptor antagonists, monitor blood pressure readings as needed during intravenous infusion, because of the risk for hypotension” Chapter 50, page 792 28. A patient with hypertension reports pain in the abdomen, for which the primary health care provider plans to prescribe antacids. Which assessment in the patient is most important in planning the medication regimen? a. Duration of abdominal pain b. Activity level of the patient c. Previous and current prescriptions d. Patient’s adherence to the treatment regimen Rationale: “Assess for contraindications, cautions, and drug interactions. Be aware that acid- controlling drugs have many interactions, so it is critical to patient safety to pay close attention to all medications the patient is taking. This underscores the importance of obtaining a thorough medication history including information about prescription drugs, OTCs, herbals, and supplements” Chapter 50, page 792 29. Which patient statements indicate effective learning about bisacodyl therapy? Select all that apply. a. "I should take the tablets along with antacids." b. "I should take the tablets on an empty stomach." c. "I should take the tablets within 1 hour of drinking milk." Rationale: “Bisacodyl, if ordered, is best taken on an empty stomach for faster action, and whole tablets are not to be chewed or crushed. Advise the patient not to take milk, antacids, or juices with the dose or within 1 hour of taking the medication” Chapter 51, page 806 30. The nurse is assessing a patient who took senna for constipation. The nurse teaches the patient about what potential side effect? a. Lethargy b. Dizziness c. Bloody stools d. Abdominal pain Rationale: “Senna (Senokot) is a commonly used OTC stimulant laxative. Senna is obtained from the dried leaves of the Cassia acutifolia plant. It may be used for relief of acute constipation or bowel preparation for surgery or examination. Because of its stimulating action on the GI tract, it may cause abdominal pain” Chapter 51, page 804 31. A patient states, “My stools are black! What should I do?” The patient is taking bismuth subsalicylate. What does the nurse do first? a. Stop the medication. b. Administer diphenhydramine. c. Call the health care provider immediately. d. Reassure the patient that this is an expected side effect of the medication. Rationale: Under table 51.2 “Selected antidiarrheals: adverse effects”: Bismuth subsalicylate has the adverse effects such as: increased bleeding time, constipation, dark stools, confusion, tinnitus, metallic taste, blue gums. Chapter 51, page 797 32. What actions will the nurse take during the insertion of a rectal suppository? Select all that apply. a. Insert the suppository as far as possible into the rectum. b. Wear gloves or a finger cot while inserting the suppository. c. Place the patient on the left side while inserting the suppository. d. Place the patient in a supine position for 30 minutes after insertion. e. Lubricate the suppository with water-soluble gel before insertion. Rationale: “Rectal suppositories, if too soft, may be placed in a medicine cup with ice to be hardened before insertion. Once the wrapper is removed, apply a water-soluble lubricant to the suppository prior to insertion into the rectum. Use a gloved hand or finger cot for insertion. Encourage the patient to try to keep the suppository in place by lying still on the left side for at least 15 to 30 minutes to allow the drug to dissolve for maximal effectiveness” Chapter 51, page 807 33. A patient is taking a stimulant laxative. What should the nurse teach the patient for safe usage? a. "This medication has to be taken with food." b. "Do not take this medication in the morning." c. "Hold other medications when taking this drug." d. "This medication can cause electrolyte and nutrient imbalances." Rationale: Under Table 51.7 “Laxatives: Averse Effects” Stimulant laxatives have adverse effects such as: Nutrient malabsorption, skin rashes, gastric irritation, electrolyte imbalances, discolored urine, rectal irritation. Chapter 51, page 802 34. Which category of laxatives is contraindicated in elderly patients? a. Emollient laxatives b. Stimulant laxatives c. Bulk-forming laxatives d. Hyperosmotic laxatives Rationale: “With hyperosmotic laxatives (e.g., polyethylene glycol, lactulose, sorbitol, glycerin), assess baseline fluid and electrolyte levels to identify any deficits prior to use. All of the previously mentioned assessment measures regarding abdominal examination and bowel patterns are also appropriate for these drugs, with an additional assessment for the presence of abdominal pain, the degree of peristalsis, and any history of recent abdominal surgery, nausea, vomiting, or weight loss. Older adult patients react more adversely to this class of laxatives, so their use is to be avoided in them” Chapter 51, page 805 35. The nurse is caring for a patient who is 2 months pregnant and is experiencing morning sickness. Which antinausea drug would the nurse expect to be prescribed for the patient? a. Dolasetron b. Palonosetron c. Promethazine d. Ondansetron Rationale: “Ondansetron (Zofran) is the prototypical drug in this class. Approved in 1992, it represented a major breakthrough in treating chemotherapy-induced nausea and vomiting and, later, postoperative nausea and vomiting. It is also used for the treatment of hyperemesis gravidarum (nausea and vomiting associated with pregnancy)” Chapter 52, page 816 36. The nurse plans to administer 50 mg of diphenhydramine intravenously. How will the nurse administer this medication? a. Undiluted over 1 minute b. Undiluted over 2 minutes c. Diluted in 100 mL D5W over 20 minutes d. Diluted in 50 mL normal saline over 30 minutes Rationale: “Undiluted forms of diphenhydramine, an antihistamine, must be cautiously administered intravenously at the recommended rate of 25 mg/min, as ordered” Chapter 52, page 818 37. A patient who is receiving chemotherapy has developed nausea and vomiting. Which drug will the nurse expect to be added to the treatment plan along with the chemotherapeutic agent? a. Ondansetron b. Scopolamine c. Promethazine d. Diphenhydramine Rationale: “The serotonin blockers are also called 5-HT3 receptor blockers because they block the 5-HT3 receptors in the GI tract, the CTZ, and the vomiting center“ “Ondansetron (Zofran) is the prototypical drug in this class. Approved in 1992, it represented a major breakthrough in treating chemotherapy-induced nausea and vomiting and, later, postoperative nausea and vomiting. It is also used for the treatment of hyperemesis gravidarum (nausea and vomiting associated with pregnancy)” (Lilley, Collins, & Snyder, 2020, Ch. 52, pg. 816). Chapter 52, oage 816 38. The nurse assesses a hospitalized patient who has nausea and vomiting who has been prescribed promethazine. What side effect might the nurse expect in this patient? a. Decreased risk of tissue damage b. Increased risk of encephalopathy c. Increased risk of low blood pressure d. Increased risk of bone marrow suppression Rationale: “Antidopaminergic drugs, such as promethazine, are to be used after cautious assessment for signs and symptoms of dehydration and electrolyte imbalance, checking skin turgor and examining the tongue for the presence of longitudinal furrows. Monitor vital signs, especially blood pressure and pulse rate, owing to the risk for the adverse effects of orthostatic hypotension and tachycardia” Chapter 52, page 817 39. Before administering the anticholinergic drug scopolamine, the nurse would be careful to assess the patient for a history of which condition? a. Glaucoma b. Gastroenteritis c. Hyperthyroidism d. Rheumatoid arthritis Rationale: “Scopolamine is also used to treat postoperative nausea and vomiting. Use of the drug is contraindicated in patients with glaucoma” Chapter 52, page 815 40. The nurse is caring for a patient who has nausea and vomiting and is prescribed metoclopramide. The nurse instructs the patient about what possible side effect? a. Hypertension b. Bronchospasm c. Motion sickness d. Tardive dyskinesia Rationale: “In 2009, the FDA posted a public health advisory regarding the potential for the development of tardive dyskinesia with long-term use of metoclopramide” Chapter 52, page 816 [Show More]

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