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NUR210 / NUR 210 Exam 1, 2, 3 & 4 Galen
Principles of Pharmacology
Tested Questions with Revised Correct Answers, (A+ Guarantee)
TABLE OF CONTENTS
NUR 210 Exam 1 ……………………
NUR 210 Exam 2 …………………… 17
NUR 210 Exam 3 …………………… 27
NUR 210 Exam 4 …………………… 75
NUR 210 Exam 1
Principles of Pharmacology - Galen
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- Medications cannot be taken with : herbals or antacids
- What kind of tablets can not be crushed?: Enteric coated
- What is a loading dose?: A large volume of medication to start working on the Problem
- Side effects: Side effects are secondary effects of drug therapy. They are predictable and can range from inconvenient to severe or life threatening. All drugs have side effects. The occurrence of side effects is one of the primary reasons patients stop taking their prescribed medicines. Our role as nurses are to educate patients about a drug's side effects and encouraging them to report side effects.
- Why are peak and trough draw levels important?: because they are request- ed for drugs that have a narrow therapeutic and are considered toxic.
- Benzodiazepine- Midazolam: Uses: Conscious sedation S/E: Dizzy Adverse reactions/ Toxicity: Respiratory depression PT teaching: Safety Contraindications: Cardiopulmonary disease
- Non- Benzodiazepine- zolpidem tartrate: Uses: Insomnia S/E: Dizziness, Drowsiness, Behavioral changes Adverse reactions/ Toxicity: Complex sleep behavior
- Local Anesthetic- Lidocaine: Uses: Minor procedure S/E: Confusion, drowsiness, stinging, bradycardia Nursing considerations: Rapid onset
- Spinal Anesthesia- Spinal, Epidural: Uses: Pain, Pregnancy S/E: Back pain, Shivering Adverse reactions/ Toxicity: Respiratory depression, Hypotension, Headache, Nerve damage Pt teaching: Lay flat, Monitor for headache
- NSAID (non-selective)- Ibuprofen: Uses: Moderate to high pain, fever, inflam- mation S/E: GI distress, Blurred vision, Fluid retention, headache, peripheral edema Adverse Reactions/ Toxicity: Seizure, Ulcer, Hearing loss, Tinnitus, Kidney damage, kidney damage, nephrotoxicity Pt teaching: take with full glass of water, take as directed, don't take more than 10 days/pain and 3 days/fever Nursing considerations: Pts with asthma, allergy, nasal polyps have high risk for reactions, assess GI bleed, look 4 renal impairment Lab values: BUN, CBC, serum creatine, liver function test will be increased, alcohol increases bleeding Contraindications: CABG, pregnancy, asthma, contraindicated in bleeding disor- ders.
- NSAID(COX 2 inhibitor)- Celecoxib: Uses: Inflammation, Severe S/E: Dizziness, GI distress, Peripheral edema, Herbal remedies Adverse reactions/ Toxicity: Thromboembolism Contraindications: CABG, Angina, Renal/ Hepatic disfunction
- NSAID(Salicylate)- Aspirin: Uses: Inflammation, anti- platelet S/E: GI distress, Nosebleed Adverse reactions/ Toxicity: Hearing, Tinnitus, Reye syndrome, Hyperuricemia Contraindications: GI bleeding, Gout, Pregnancy
- Anti-gout- Allopurinol: Uses: Lowers uric acid
Lab values: Liver enzymes Contraindications: hepatic/ renal dysfunction
- Opioid Antagonist (NARCAN)- Naloxone: Uses: Opioid overdose, Reserves respiratory depression S/E: N/V, hypertension, hypotension Adverse reactions/ Toxicity: Ventricular arrhythmias Nursing Considerations: monitor respiratory rate, BP, and pulse, given in slow increments.
- Anti- (Migraine)- Sumatriptan: Uses: Migraines, Cluster headache S/E: Drowsy, Flushing, warm sensation Adverse reactions/ Toxicity: Bradycardia Pt teaching: Only use during a migraine attack, avoid alcohol, overuse can cause headache Contraindications: History of hypertension, liver failure, pregnancy
- CNS Stimulant- (Amphetamine Like drug)- Methylphenidate: Uses: ADHD, Narcolepsy S/E: Insomnia, Irritability, weight loss, decreased appetite Adverse reactions/ Toxicity: Growth suppression, Hypertension, Tachycardia, sud- den death, anaphylaxis, PT teaching: Take early in day, Eat more calories
Nursing considerations: Monitor height/weight Contraindications: Anxiety, hypertension, history of seizures, coronary artery dis- ease
- Antiseizure- (Valproate)- Valproate acid: Uses: Seizures S/E: Drowsy, Dizzy Adverse reactions/ Toxicity: hepatotoxicity, suicidal thoughts Pt teaching: monitor CBC, platelets, bleeding time Nursing considerations: Institute seizure, precautions, assess suicidal tendencies Contraindications: Pregnancy, PT's with liver disease ( Take 2-3 hours before or after antacids)( Take @ same time every day)
- Antiseizure- Barbiturate- Phenobarbital: Uses: Anti-convulsant S/E: Drowsy, Dizzy Adverse reactions/ Toxicity: Respiratory depression if you take too much Pt teaching: Notify PCP of S/S of angioedema, fever, sore throat, swelling, nose bleeds, No alcohol Nursing considerations: Monitor BP, Pulse, Resp, S/S of angioedema Lab values: Hepatic function, renal function, CBC Contraindications: Pregnancy ( Take 2-3 hours before or after antiacids)( Take @ same time every day)
- Antiseizure- Hydantoin- Phenytoin: Uses: prevention of grand mal Seizures S/E: Red/pink urine, N/V, thick gums, drowsy, hypotension, ataxia Adverse reactions/ Toxicity: Steven Johnson syndrome, blood dysrasia, aplastic anemia, suicidal thoughts, cardiac arrest
Pt teaching: advice of abuse potential, avoid alcohol & opioids. Nursing considerations: Monitor BP, pulse, resp, assess risk for abuse, addiction misuse. Lab values: Hepatic & renal function, CBS Contradictions: Do not take with other CNS
- Antipsychotic- Haloperidol: Uses: Schizophrenia, Acute sycosis S/E: Dry mouth, Sedation Adverse reactions/ Toxicity: EPS(Tremors) NMS(fever, rigidity) Contradictions: Mood stabilizers & antipsychotics
- half life: the amount of time it takes for the drug to be reduced to half
- onset: is the time it takes for a drug to reach the minimum effective concentration (MEC) after administration.
- peak: occurs when it reaches its highest concentration in the blood.
- Duration of Action: is the length of time the drug exerts a therapeutic effect.
- Atypical Antipsychotic- Aripiprazole: Uses: Schizophrenia S/E: Dryness, Weight gain, Drowsy, Sedation anticholinergic effects Adverse reactions/ Toxicity: Suicidal ideation, EPS, NMS Pt teaching: Nursing considerations: Wont work overnight about 3 weeks Lab values: Monitor CBC, blood glucose, cholesterol levels
- SNRI- Venlafaxine: Uses: anti- depression S/E: Dryness, urinary retention Adverse reactions/ Toxicity: Renal failure, Steven Johnson Syndrome Lab values: BUN, Creatine
- Tricyclic- Amitriptyline: uses: depression
- MAO inhibitor- Phenelzine Sulfate: Uses: Depression S/E: Agitation, Restless, Dizzy, Drowsiness Adverse reactions/ Toxicity: Hypertensive crisis PT teaching: Stay away from foods with tyramine & cold meds Nursing considerations: Stay away from herbal remedies
- Mood Stabilizer- Lithium: Uses: Bipolar disorder S/E: Headache, Drowsy, Drop in BP Adverse reactions/ Toxicity: Seizure activity due to drop in sodium, Toxicity Pt teaching: Take around the same time daily Lab values: Anything over 1.5 is toxic
- SSRI- Fluoxetine: Uses: Depression S/E: Headache, Sexual dysfunction Adverse reactions/ Toxicity: Drop in blood sugar, Seizures, Steven Johnson Syn- drome, suicidal Ideations Pt teaching: Take at the same time daily. Nursing considerations: Watch over suicidal thoughts
- Peak Drug Levels: o Orally, the peak time is usually 2 to 3 hours after drug administration. o Intravenously, the peak time is usually 30 to 60 minutes after the infusion is
- Additive Drug Effects: When two drugs are administered in combination, and the response is increased beyond what either could produce alone.· In other words, DRUG + DRUG = 2
- Synergistic Drug Effects: When two drugs are given together is substantially greater than that of either drug alone.· In other words, DRUG + DRUG = 10o More bang for your buck!
- It is common for the geriatric population to have : o Multiple physicians o Multiple pharmacy (polypharmacy)
- You want the patient to at least: use the same pharmacy
- If a patient has multiple physicians or pharmacies : -patient is at risk for drug overlaps -you should call pharmacy to consult medication list
- Toxicity side effects for the geriatric population includes:: o Change in behavior o Change in mentality o Confusion
- If patient has not taken medications...: o NEVER assume. ALWAYS assess first. o Ask patient, "How is medications taken" o Find a way to ask about why medications have not been taken by not being judgmental
- Teaching and Administrating Nose Drops and Sprays: Hand hygiene· Advise patient to blow nose· Advise patient to tilt head back for drops to reach the frontal sinus and to tilt head
to the affected side to reach the ethmoid sinus· Administer prescribed number of drops or sprays o Without touching the tip of the medication applicator to the nasal passages· Some sprays have instructions to close one nostril, tilt head to the closed side, and hold the breath or breathe through the nose for 1 minute.· If patient is using a nasal spray to reach the sinuses, proper head position is with the patient looking down at feet with the spray tip aimed toward the eye.· Advise patient to keep the head tilted back for 5 minutes after instillation of drops.
- Teaching and Administering Eyedrops: Hand hygiene· Instruct patient to lie down or sit back in a chair and have them look at the ceiling.· Remove any discharge by gently wiping from the inter to outer canthus. o Use a separate cloth for each eye.· Gently draw the skin down below the affected eye to expose the conjunctival sac.· Notify patient immediately before drops are administered so they avoid blinking when
o View amount at eye level. · Measure liquid medication in a mL syringe and squirt liquid into dosing cup. · Suspension/elixir (page 97)-Elixirs are sweetened, hydro alcoholic liquids used in the preparation of oral liquid medications. Emulsions are a mixture of two liquids that are not mutually soluble. Suspensions are liquids in which particles are mixed but not dissolved. · Tablets/Capsules (page 97)· IO=means intraosseous
- Rectal Suppository: · Remove foil from around suppository· Lubricate before insertion· Explain administration procedure to patient and provide for patient privacy· Place gloves on· Instruct patient to lie in the Sims position and to breathe slowly through the mouth to relax the anal sphincter.· During insertion, place the suppository past the internal anal sphincter
- IO: means intraosseous
- Topical: applied to the skin by painting or spreading the medication over an area and applying a moist dressing or leaving the area exposed to air. Can be applied with a glove, tongue blade, or cotton-tipped applicator. Never apply a topical medication without first protecting your own skin with gloves
- Transdermal: A patch with is placed on the skin and absorbed through the skin. May be left for as little as 12 hours or as long as 7 days depending on the drug. Should be rotated to different sites to prevent skin breakdown. Never cut a patch in half. Always remove old patch before applying new one.
- Appropriate Drug Orders: · Patient name and D.O.B· Date the order is written· Provide signature or name if an electric order, T/O, or V/O· Signature of licensed staff who took the T/O or V/O, if applicable· When prescribing controlled substances, the HCP's DEA number must be on the prescription· Drug name and strength· Drug frequency or dose· Route of administration· Number of patient refills· Number of pills to be dispensed· Any special instructions for withholding or adjusting dosage based on nursing assessment, drug effectiveness, or lab results
- With questions that say "Which of the following client statements would require further teaching?": Those mean to look for the questions with the WRONG answer.
- s/s:Polyuria, Polydipsia, Polyphagia, Weight loss, fatigue, increase fre- quency of infections, rapid onset, insulin dependent, familial tendency, peak incidence from 10-15 years. Answer DM I
- Polyuria, Polydipsia, Recurrent infections, visual changes, fatigue, de- crease energy, HbA1c greater than 6.5, FBS greater than 126, Prediabetes FBS 100-125, Metabolic Syndrome increase for diabetes, increase triglycerides, decrease HDLs, increase B/P, Central obesity, sedentary lifestyle, FBS greater than 126, most common when over 35. Answer DM II
- Onset rapid 1-3 hours, s/s:anxious, sweaty, hungry, confused, blurred or double vision, shaky, irritable, cool and clammy skin / treatment goal is BS over 70mg. Answer Hypoglycemia
- Onset 4-10 hours (lack of insulin), Breath smells like fruit - kussmal respi- rations, thirsty dehydration, tachycardia, hypotension, acidosis, high BS >240, hyperkalemia, polyuria. Need hydration, insulin, electrolyte replacement.
Answer Diabetic Ketoacidosis
- Given when a person is unconscious from hypoglycemia due to insulin overdose, administered SQ, IM or preferred IV. Answer Glucagon
- Should be given no more than 5 mins before meals. Answer Rapid Acting Insulin
- Peaks in 1/2 hr to 2 1/2 hrs Answer Lispro / Nuvolg
- Short Acting, given 30 mins before meals, peaks in 2.5-5 hrs, lasts 6- hours Answer Regular Insulin
- Intermediate Acting, Peaks in 6-12 hrs, duration is 18-24 hrs Answer NPH, Humulin N