Download NR 565 Pharmacology Final Exam 2024 Update Actual Questions and Answers Solved 100% and more Exams Nursing in PDF only on Docsity!
Signs and symptoms of hypothyroidism - Face is pale, puffy, and expressionless.
Skin is cold and dry.
hair is brittle, and hair loss occurs.
Heart rate and temperature are lowered. The patient lethargy, fatigue, and intolerance to cold.
Mentation may be impaired.
Signs and symptoms of hyperthyroidism - Heart Rate is Rapid; Possible arrhythmia/angina
Nervousness, insomnia, rapid thought flow, and rapid speech
Skeletal muscles may weaken and atrophy
Metabolic rate is raised, resulting in increased heat production, increased body temperature, intolerance to heat, and skin that is warm and moist
Weight loss occurs if caloric intake fails to match the increase in metabolic rate
Severe hypothyroidism - Myxedema
Hypothyroid Treatment - Levothyroxine is the drug of choice for most patients who require thyroid hormone replacement.
Levothyroxine (Synthroid) Therapeutic Goal - Resolution of signs and symptoms of hypothyroidism and restoration of normal laboratory values for serum thyroid-stimulating hormone (TSH) and free thyroxine (T4).
Major forms of hyperthyroidism - Graves disease and toxic nodular goiter (also known as Plummer disease).
NR 565 Pharmacology Final Exam 2024
Update Actual Questions and Answers
Solved 100%
Graves Disease - Most common cause of excessive thyroid hormone secretion
What adjunctive therapy is good to prescribe to control symptoms of hyperthyroidism other than thyroid specific medications? - β-Blockers and nonradioactive iodine may be used as adjunctive therapy.
β-Blockers suppress tachycardia by blocking β-receptors on the heart.
Nonradioactive iodine inhibits synthesis and release of thyroid hormones.
Monitoring needs and intervals for Levothyroxine - Check TSH 6-8 weeks after initiating therapy and after any dosage change.
Check TSH at least once a year after serum TSH is stabilized.
Hyperthyroid Treatment - thionamide drugs—methimazole and propylthiouracil (PTU)—suppress synthesis of thyroid hormones.
Methimazole Therapeutic Goal - (1) reduction of thyroid hormone production in Graves' disease, (2) control of hyperthyroidism until the effects of radiation on the thyroid become manifest, (3) suppression of thyroid hormone production before subtotal thyroidectomy, (4) treatment of thyrotoxic crisis.
Monitoring needs and intervals for Methimazole - Check CBC with differential if signs or symptoms of infection. Check LFTs if signs or symptoms of liver dysfunction.
High Risk Patients for Methimazole - Should be avoided in the first trimester of pregnancy.
Methimazole Toxicity - Agranulocytosis is the most dangerous toxicity.
PTU High Risk Warning - Carries a risk for liver toxicity. Although rare, the FDA recommends against using as a first-line treatment due to potential for hepatic toxicity.
Effects of maternal hypothyroidism on offspring and appropriate patient teaching related to need for treatment. - Can cause delay in mental development and derangement of growth. In the absence of thyroid hormones, the child develops a large and protruding tongue, potbelly, and dwarfish stature. Development of the nervous system, bones, teeth, and muscles is impaired.
HbA1C Goal for Older Adults - <7.5% [58 mmol/mol]), while those with multiple coexisting chronic illnesses, cognitive impairment, or functional dependence should have less stringent glycemic goals (such as A1C <8.0-8.5% [64-69 mmol/mol]).
Criteria for the Diagnosis of Diabetes Mellitus - -Fasting plasma glucose ≥126 mg/dL
-Random plasma glucose ≥ 200 mg/dL plus symptoms of diabetes
-Oral glucose tolerance test (OGTT): 2-h plasma glucose ≥200 mg/dLcor
-Hemoglobin A1c 6.5% or higher
T1DM Etiology and MOA - Autoimmune process; Loss of pancreatic β cells;
T2DM Etiology and MOA - Unknown—but there is a strong familial association, suggesting that heredity is a risk factor; Insulin resistance and inappropriate insulin secretion
the total daily dose (TDD) of insulin calculation - total weight of the patient in kilograms (kg), multiplied by 0.6 units
Basal insulin replacement - 50% of the total daily insulin dose which replaces insulin from fasting (overnight) and between meals.
Bolus insulin replacement - 50% of the total daily insulin dose and provides carbohydrate coverage and high blood sugar correction.
Biguanides Drug Class - Metformin
Metformin - Decreases glucose production by the liver (glucogenesis), increases tissue response to insulin;
Decrease glucose absorption; Increase glucose uptake
drug of choice for initial therapy in most patients with type 2 diabetes
Metformin contraindications - renal disease, acidosis from hepatic disease, alcoholics, or in patients with hypoxia.
Metformin Major AE - Gastrointestinal (GI) symptoms: decreased appetite, nausea, diarrhea
Lactic acidosis (rarely)
Sulfonylureas Prototype/MOA - Glyburide (Prototype Drug)
-Promote insulin secretion by the pancreas; may also increase tissue response to insulin;
-stimulate beta cells of the pancreas to secrete more insulin
Sulfonylureas AE - high risk of severe hypoglycemia;
photosensitivity; therefore, patient education is needed regarding sunscreen.
blood dyscrasias
weight gain.
Sulfonylureas Contraindication - should be avoided in patients with impaired hepatic or renal function.
Meglitinides (Glinides) Prototype/MOA - -Repaglinide (Prototype Drug)
-stimulation of pancreatic insulin release though shorter acting then sulfonylureas and are taken with each meal
-Facilitates calcium influx in pancreatic β cells, which leads to increased insulin release
Meglitinides Main AE - Hypoglycemia
Meglitinides Contraindications - Use with caution in patients with liver impairment and those taking gemfibrozil.
-Reduces the reabsorption of glucose, increasing urinary excretion of glucose
Sodium-Glucose Cotransporter 2 Inhibitors Contraindications - Use with caution in patients prone to vulvovaginal and urinary tract infections.
Sodium-Glucose Cotransporter 2 Inhibitors Main AE - Educate patients on signs and symptoms of hypoglycemia. These drugs also cause a diuretic effect; therefore patients should stay hydrated and monitor for signs and symptoms of urinary tract or vulvovaginal infections.
α-Glucosidase Inhibitors MOA/Prototype - -Acarbose (Prototype Drug)
-delays absorption of dietary carbohydrates and thereby reduces the rise in blood glucose after a meal
α-Glucosidase Inhibitors main AE - flatulence, cramps, abdominal distention, borborygmus (rumbling bowel sounds), and diarrhea.
Glucagon Like Peptide-1 Receptor Antagonists (GLP-1) - -Non Insulin Injectable
-Exenatide (Byetta) (Prototype Drug);
Liraglutide (Victoza)
Dulaglutide (Trulicity)
Lixisenatide (Adlyxin)
-Activates receptors for GLP-1- slowing gastric emptying, inhibits glucagon, suppresses appetite, and stimulates glucose-dependent release of insulin
Glucagon-like Peptide-1 Receptor Antagonists Contraindication - should be used with caution in pregnancy; benefits should clearly outweigh risks. Avoid use in patients with renal dysfunction or patients that have undergone renal transplant. Use with caution in patients with a history of pancreatitis.
Glucagon-like Peptide-1 Receptor Antagonists Main AE - Educate patients on the signs and symptoms of hypoglycemia. These drugs also delay gastric emptying, so may delay the absorption of other drugs if taken simultaneously.
Drugs More Likely To Cause Hypoglycemia - insulin
sulfonylureas = (Glyburide)
meglitinides = (Glinides==>Repaglinide)
amylin analogues
Drugs Less Likely To Cause Hypoglycemia - incretin mimetics = (GLP-1) Receptor Agonists
metformin
thiazolidnediones = (Glitazone)
DDP-4 inhibitors = (Gliptins)
The first-line treatment for all patients with diabetes - Metformin and lifestyle changes
Know what type of insulin and how much is needed according to carbohydrate intake. - The mealtime carbohydrate-to-insulin dose is calculated using the 450 rule for regular insulin and the 500 rule for rapid-acting insulin; thus insulin dose (regular or rapid acting) is divided by the TDD insulin; The carbohydrate-to-insulin ratio is 1:(regular or rapid acting insulin/TDD)
Insulin Mixing Guidelines - NPH insulin is appropriate for mixing with short-acting insulins
Insulin - -rapid-acting insulin only covers one meal at a time
-regular insulin provides coverage from meal to meal or the time between meals
-NPH insulin lasts all day or from breakfast to dinner
-Lantus is a once-daily dosing option
Short Duration: Rapid Acting Insulin - Insulin lispro (Humalog)
Insulin aspart (Novolog)
Insulin glulisine (Apidra)
Short Duration: Short Acting Insulin - Regular insulin (Humulin R, Novolin R)
LABA
Ages 12-Adult: SABA PRN + High-dose IGC + LABA
AND consider omalizumab for patients with allergies
6th Step Therapy For Asthma Treatment - Ages 0-4: SABA PRN + High-dose IGC + LABA/montelukast + Oral glucocorticoids
Ages 5-11: SABA PRN + High-dose IGC + LABA +
Oral glucocorticoids
Ages 12-Adult: High-dose IGC + LABA + Oral glucocorticoids and Consider omalizumab for patients with allergies
Asthma Severity Classification Domains - Impairment and Risk.
Impairment - effect of asthma on quality of life and functional capacity in the present
Risk - possible adverse events in the future, such as exacerbations and progressive loss of lung function.
Intermittent Asthma (Initial Treatment) - Symptoms 2d/week or less; SABA use 2d/week or less; No effect on activity-->Step 1 Treatment
Mild Persistent Asthma (Initial Treatment) - Symptoms more than 2 d/wk but less than daily; SABA use more than 2 d/wk but less than daily; Minimal Activity Limitation-->Step 2 Treatment
Moderate Persistent Asthma (Initial Treatment) - Symptoms daily. Some limited activity; Weekly nighttime awakenings.
Severe Persistent Asthma (Initial Treatment) - Symptoms several times daily; Severe activity limitation
Ages 0-4: Step 3 Treatment
Ages 5-11: Step 4 Treatment
Ages 12-Adult: Step 4 or 5 Treatment
Well Controlled Asthma - Continue current therapy.
Reevaluate in 1-6 months.
May step down after control well maintained for 3 months.
Not Well Controlled Asthma (0-4 y/o) - Step up therapy by 1 step.
Reevaluate in 2-6 weeks.
If no improvement in 4-6 weeks, consider adjusting therapy or consider alternative diagnoses.
Not Well Controlled Asthma (5-Adult) - Step up therapy by at least 1 step.
Reevaluate in 2-6 weeks.
Very Poorly Controlled Asthma - Step up therapy by 1-2 steps.
Consider short course of oral systemic glucocorticoids.
Reevaluate in 2 weeks.
Inhaled β2 agonists - most effective drugs available for relieving acute bronchospasm and preventing exercise induced asthma (EIB).
β2 agonists MOA - sympathomimetic drugs that activate β2-adrenergic receptors; promote bronchodilation
SABA - used as needed (PRN) for prophylaxis of exercise-induced bronchospasm and to relieve ongoing asthma attacks and chronic obstructive pulmonary disease exacerbation
SABA Inhalations Preparations - MDIs, DPIs, and nebulizers
Inhaled Glucocorticoids Main AE Long Term, High-Dose - adrenal suppression may develop
Inhaled Glucocorticoids Patient Teaching - rinse the mouth with water and gargle after each administration.
Patient teaching for short-acting β2 agonist (SABA) and a glucocorticoid - delivery of glucocorticoids to the airways can be enhanced by inhaling a SABA 5 minutes before inhaling the glucocorticoid.
Inhaled glucocorticoids contraindication - patients with persistently positive sputum cultures for Candida albicans.
Oral Glucocorticoids - may be required for patients with moderate to severe persistent asthma or for management of acute exacerbations of asthma or COPD when symptoms cannot be controlled with safer medications (inhaled glucocorticoids, inhaled β2 agonists).
Oral Glucocorticoid AE - prolonged therapy, even in moderate doses, can be hazardous. Potential adverse effects include adrenal suppression, osteoporosis, hyperglycemia, peptic ulcer disease, and, in young patients, growth suppression.
Glucocorticoids Prototype Drugs - Beclomethasone, Budesonide, Fluticasone (inhaled)
Prednisone, Methylprednisolone (oral)
Leukotriene Receptor Antagonists (LTRA) MOA - block the action of leukotrienes in the lungs and bronchial tubes, which reduces bronchoconstriction. used for the prevention and chronic treatment of asthma and the prevention of exercise-induced bronchospasm in both adults and children.
Montelukast (Singulair): - most commonly used leukotriene modulator. The drug has three approved indications: (1) prophylaxis and maintenance therapy of asthma in patients at least 1 year old; (2) prevention of exercise-induced bronchospasm (EIB) in patients at least 15 years old; and (3) relief of allergic rhinitis
Black Box Warning for Montelukast (Singulair) - Drug is known to cause serious neuropsychiatric effects such as agitation, aggression, insomnia, depression, anxiety, and suicidal ideation.
Mast Cell Stabilizers Prototype Drug - Cromolyn (Inhalation)
Mast Cell Stabilizers MOA - is used for prophylaxis—not quick relief—in patients with mild to moderate asthma; prescribed for exercise-induced asthma. They STABILIZE MAST CELLS TO REDUCE HISTAMINE RELEASE; , an inflammatory mediator.
Cromolyn patient teaching - should be administered 10 to 15 minutes before anticipated exertion but no longer than 1 hour before exercise.
Advantages of Inhaled Route of Anti-Asthma Drugs - (1) therapeutic effects are enhanced by delivering drugs directly to their site of action, (2) systemic effects are minimized, and (3) relief of acute attacks is rapid.
Methylxanthines MOA - Bronchodilation to decrease the intensity and frequency of moderate to severe asthma attacks and to control chronic obstructive pulmonary disease exacerbations
Methylxanthines Prototype Drug - Theophylline
Theophylline Toxicity Risk - can cause severe cardiac dysrhythmias and convulsions
Methylxanthines Contraindication - These drugs are contraindicated for patients with untreated seizure disorders or peptic ulcer disease
Theophylline contraindication w/ Caffeine - can intensify the adverse effects of the drug on the heart and CNS; Can decrease drug metabolism.
Theophylline contraindication w/ Smoking Tobacco or Marijuana - can increase clearance to 50% in adults and 80% in older adults; Can cause an ineffective dosing.
Drugs that Reduce Theophylline Levels (CYP3A Inducers) - Phenobarbital, phenytoin, rifampin; May need to increase drug level if given in conjunction; Increase metabolism rate of target drug;
improve lung function by blocking muscarinic receptors in the bronchi, reducing bronchoconstriction.
Anticholinergic Drugs Contraindication - patients with acute narrow-angle glaucoma or an enlarged prostate.
Nicotine-Free Products Smoking Cessation Products - Bupropion SR (Zyban); Varenicline (Chantix)
Bupropion SR (Zyban) MOA - an atypical antidepressant; blocks uptake of norepinephrine and dopamine.
Bupropion SR (Zyban) AE - Dry mouth
Insomnia
Weight loss
Bupropion SR (Zyban) Contraindication - MAOIs
Wellbutrin
Use with caution in patients with history of seizure, anorexia nervosa, cocaine use, and alcohol withdrawal.
Wellbutrin - Trade name of Bupropion when sold for depression; Same Drug
Bupropion SR (Zyban) Black Box Warning - Can cause serious neuropsychiatric effects, including mood changes, erratic behavior, and suicidality. Should be used with caution in patients with a history of psychiatric disease.
Bupropion SR (Zyban) Duration - Decrease use after 7-12 weeks
Varenicline (Chantix) MOA - partial agonist at nicotinic receptors, and most effective aid to smoking cessation
Varenicline (Chantix) AE - Nausea;
Can increase the risk for cardiovascular events (e.g., angina pectoris, peripheral edema, hypertension, nonfatal myocardial infarction) in patients with stable cardiovascular disease.
Varenicline (Chantix) Contraindication - Use by truck drivers, bus drivers, airplane pilots, and air traffic controllers is banned due to unpredictable physical and psychiatric adverse effects. Monitor patients with known cardiovascular disease closely.
Varenicline (Chantix) Duration - Decrease use after 12 weeks
Nicotine patch (NicoDerm CQ) Benefits - Nonprescription; provides a steady level of nicotine; easy to use; unobtrusive
Nicotine patch (NicoDerm CQ) Duration - 8-10 weeks
Nicotine patch (NicoDerm CQ) Patient Education - applied once a day to clean, dry, nonhairy skin of the upper body or upper arm. Site should be changed daily and not reused for at least 1 week. patches are left in place for 24 hours and then immediately replaced with a fresh one
Nicotine gum (Nicorette, others) Benefits - Nonprescription; user controls dose;
Nicotine gum (Nicorette, others) Patient Education - chew the gum slowly and intermittently for approximately 30 minutes; should not eat or drink while chewing or for 15 minutes before chewing
Nicotine gum (Nicorette, others) Duration - Use beyond 6 months is not recommended
Nicotine lozenge (Nicorette Lozenge, Thrive ) Benefits - Nonprescription; user controls dose; easier to use than nicotine gum
Nicotine lozenge (Nicorette Lozenge, Thrive ) Duration - Dosing should decrease over a period of 12 weeks
Dosing should stop after 12 weeks
Isoniazid and Rifampin - mothers taking these drugs for TB should be encouraged to breastfeed.
TB Treatment considerations for older patients - No contraindications are identified. Dosing may need to be adjusted for patients with decreased renal function.
Cimetidine (Tagamet) CYP450 Enzyme Interaction - Weak Inhibitor of CYP450 enzyme; concern for use w/ warfarin, phenytoin, theophylline, and lidocaine;
Omeprazole/PPI CYP450 Enzyme Interaction - Inhibits Plavix Effectiveness due to inhibition of CYP2C19, the isoenzyme of cytochrome P
Aprepitant (Emend) CYP450 Enzyme Interaction - Antiemetic drug; a substrate for, inhibitor of, and inducer of CYP3A4; Warfarin Rifampin
Nutritional deficiencies associated with long term PPI use - Decreased absorption of calcium, magnesium, and vitamin B12 have also been associated with long-term use;
PPI Contraindication - Individuals with hypocalcemia due to complications of bone fractures;
Increased risk limited to the first few days of PPI use for community-acquired and hospital-acquired pneumonia. - Omeprazole and other PPIs
Infant Care for PUD - PPIs and H2 receptor antagonists are used safely in infants as young as 1 month to treat GERD and duodenal ulcers.
Children/adolescents Care in PUD - PPIs and H2 receptor antagonists can be used safely in in smaller doses.
Pregnancy Care for PUD - Misoprostol must be avoided at all costs. Some PPIs (esomeprazole) and H receptor antagonists (ranitidine) are safe for use in pregnancy.
Breastfeeding/Care for PUD - Use of drugs such as omeprazole, esomeprazole, and ranitidine is not predicted to cause any adverse effects
Older adults/Care for PUD - PPIs are associated with increased risk for fractures from osteoporosis. PPIs can also cause medication interactions and vitamin or mineral deficiencies. There should be a clear indication for prescribing these medications in this population.
Infants Laxatives/Constipation - Docusate, lactulose, and glycerin suppositories have been used to treat constipation safely
Children and Adolescents Laxative/Constipation - Milk of magnesia, mineral oil, senna, docusate, and bisacodyl can be used to treat constipation
Pregnancy Laxative/Constipation - Laxatives should be used cautiously in pregnancy because gastrointestinal stimulation can induce labor.
Breastfeeding Laxative/Constipation - Senna is safe for use during breastfeeding. Data are lacking regarding the use of polyethylene glycol and bisacodyl (Dulcolax); caution is advised.
Older Adults Laxative/Constipation - All laxatives discussed in this chapter can be used in the older- adult population. The older adult should be monitored closely for dehydration.
Bulk-Forming Laxatives MOA - Absorb water, thereby softening and enlarging the fecal mass; fecal swelling promotes peristalsis; Group 3 Laxative
Bulk Forming Laxative Examples - Methylcellulose (Citracel)
Psyllium (Metamucil)
Polycarbophil
Bulk Forming Laxative Indication - temporary treatment of constipation; widely used in patients with diverticulosis and irritable bowel syndrome; can provide symptomatic relief of diarrhea and can reduce discomfort and inconvenience for patients with an ileostomy or colostomy.
