Download Nurs350 Pharmacological Therapeutics, Final Exam Blueprint and more Study Guides, Projects, Research Nursing in PDF only on Docsity!
Nurs350 Pharmacological Therapeutics, Final
Exam Blueprint.
1. Principles of Drug Administration (6-8 questions)
2. Pharmacokinetics and Pharmacodynamics ( 4-
questions) 3.Drugs administration throughout the
lifespan ( 1-3) questions
4. Cholinergic and Anticholinergic Drugs ( 3-5 questions)
1. CHOLINERGIC DRUGS (4-6 questions) - Two types of cholinergic receptors: - Nicotinic receptors (named this because nicotine binds to these receptors) o Located at ganglionic synapse in both sympathetic and parasympathetic divisions o Response stimulate smooth muscle and gland secretion - Muscarinic receptors (named this because muscarine from poisonous mushrooms binds to these receptors) o Located in the parasympathetic target organs expect the heart (decreases HR and force of contraction. - Parasympathomimetic - Direct acting: Bind to cholinergic receptors to produce the rest-and- digest response o Motor for I&Os, blurred vision, and orthostatic hypotension o Decrease HR, BP; increase GI, constriction of the pupil - Indirect acting: Inhibit the action of A C h E; High potential for serious adverse effects - Bethanechol (Urecholine) – Direct Acting - Mechanism of action : to activate the parasympathetic nervous system directly/indirectly, induce rest/digest response - Uses : glaucoma, urinary retention, myasthenia gravis, Alzheimer disease - Adverse effects : profuse salivation, sweating, increased muscle tone, urinary frequency, bradycardia, diarrhea - Administration Alerts o Never administer I M or I V; 5mg 3-4 times day PRN o Monitor blood pressure, pulse, and respirations before administration and for at least 1 hour after subcutaneous administration o Do not take with milk or food, administer with empty stomach to induce absorption o Pregnancy category C - Contraindications: Patients with:
o asthma
o Monitor for increased ease of urination, muscle strength and coordination improved, lessened ptosis, improved swallowing o CHLOLINERGIC CRISIS : increase salivation, constrict pupils, muscle twitching, unusual paleness, sweating, muscle weakness, and difficulty breathing, diarrhea, profuse sweating, urinary urgency,
2. ANTICHOLINERGIC DRUGS (2-4 questions) o Drugs that inhibit parasympathetic impulses o Suppression of parasympathetic division induces fight-or-flight symptoms o Uses are predictable extension of parasympathetic-blocking effects o Effects include: i. Pupil dilation (mydriasis) ii. Increasing heart rate iii. Drying glandular secretions iv. Relaxing bronchi (asthma) o Uses include: i. Peptic ulcer disease – helps with abdominal cramping ii. Ophthalmic procedures iii. Heart rhythm abnormalities iv. Anesthesia adjunct v. Asthma and C O P D vi. Overactive bladder vii. Parkinson disease a. Atropine (Atro-Pen)
- Mechanism of action : to inhibit the parasympathetic nervous system;
- Therapeutic Class: Antidote for anticholinesterase poisoning
- Primary use: peptic ulcers, irritable bowel syndrome, mydriasis and cycloplegia during eye examination, bradycardia, preanesthetic, asthma - Adverse effects : tachycardia, C N S stimulation (confusion), dry mouth, constipation, urinary retention, dry eyes, decreased sweating, photophobia - Administration Alerts o Monitor blood pressure, pulse, and respirations before administration and for at least 1 hour after subcutaneous administration o Oral and subcutaneous dose are not interchangeable. o Avoid alcohol, caffeine, smoking, and aspirin at bedtime. o Given before surgery commonly – decrease excessive respiratory secretions and reverse the bradycardia cause
by general anesthetics.
xii. Assess for desired therapeutic effects dependent on the reason for the drug (e.g., increased ease of breathing, cardiac rhythm stable, B P within normal range). xiii. Continue frequent and careful monitoring of vital signs, urinary output and cardiac monitoring as appropriate. xiv. Assess for and promptly report adverse effects: tachycardia, hypertension, dysrhythmias, tremors, dizziness, headache, or decreased urinary output. xv. Seizures or ventricular tachycardia may signal drug toxicity and should be immediately reported.
5. Drugs for Seizures ( 2-3 questions)
3. Anti-Seizure Medications (5-8 questions) - Convulsions Involuntary violent spasm of large muscles of face, neck, arms, and legs; Not synonymous with seizure - Known Causes of Seizures: fever, infectious diseases, metabolic disorders, neoplastic disease, trauma, vascular diseases, medications, high doses of local anesthetics, eclampsia, drug abuse, withdrawal syndromes from alcohol or sedatives- hypnotics drugs - Epilepsy Seizures occurring chronically o International Classification of Epileptic Seizures ▪ Partial (focal) - Simple Partial o Olfactory, auditory, and visual hallucinations o Intense emotions o Twitching of arms, legs, and face - Complex partial o Aura (preceding) o Brief period of confusion or sleepiness afterward with no memory of seizure (postictal confusion) o Fumbling with or attempting to remove clothing o No response to verbal commands
▪ Generalized - Absence (petit mal) **o** Lasting a few seconds **o** Seen most often in children (child stares into space, does not respond to verbal stimulation, may have fluttering eyelids or jerking) **o** Misdiagnosed often (especially in children) as attention deficit/hyperactivity disorder (A D H D)
or daydreaming
▪ Primary use: controlling seizures ▪ Adverse effects: dependence, drowsiness, vitamin deficiencies, laryngospasm ▪ Monitor patient’s condition ▪ Liver and kidney function ▪ Pregnancy category D ▪ Common side effects ▪ Therapeutic Class: Antiseizure drug; sedative ▪ Pharmacologic Class: Barbiturate; G A B A (^) A receptor agonist ▪ Actions and Uses
- Phenobarbital is a long-acting barbiturate used for the management of a variety of seizures. It is also used to promote sleep..
- Phenobarbital acts biochemically by enhancing the action of the G A B A neurotransmitter, which is responsible for suppressing abnormal neuronal discharges that can cause epilepsy. ▪ Contraindications:
- hypersensitivity to barbiturates
- severe uncontrolled pain,
- pre-existing C N S depression,
- severe respiratory disease with dyspnea or obstruction
- glaucoma
- prostatic hypertrophy. ▪ Interactions Drug–Drug:
- should not be taken with alcohol or other C N S depressants.
- These substances potentiate barbiturate action, increasing the risk of life- threatening respiratory depression or cardiac arrest. ---Phenobarbital increases the metabolism of many other drugs, reducing their effectiveness. ▪ Lab Tests: Barbiturates may increase serum phosphatase. ▪ Herbal/Food: Kava and valerian may potentiate sedation ▪ Treatment of Overdose:
- gastric lavage or use of activated charcoal.
- Haemodialysis may be effective in facilitating removal of phenobarbital from the body.
- Treatment is supportive and consists mainly of endotracheal intubation and mechanical ventilation.
- Treatment of bradycardia and hypotension may be necessary o NURSING : ▪ Low margin for safety
▪ High potential for dependence ▪ Cause profound C N S depression ▪ Overall effective against all major seizure types except absence seizures ▪
- Benzodiazepines o Schedule I V Drug ▪ Monitor for drug-abuse potential ▪ Pregnancy risk—pregnancy category D ▪ Contraindicated in narrow-angle glaucoma ▪ Respiratory depression may result with other C N S depressants ▪ Common side effects include dizziness, drowsiness ▪ Overdose—give flumazenil (Romazicon) o Prototype drug : diazepam (Valium) ▪ Clobazam (Onfi), Clonazepam (Klonopin), Clorazepate (Tranxene), Diazepam (Valium), Lorazepam (Ativan) ▪ Mechanism of action : similar to that of barbiturates but safer ▪ Primary use : for short-term seizure control ▪ Adverse effects : drowsiness and dizziness ▪ Administration Alerts - When administering I V, monitor respirations every 5 to 15 minutes. Have airway and resuscitative equipment accessible.
- Pregnancy category D ▪ Adverse Effects - Because of tolerance and dependency, use of diazepam is reserved for short-term seizure control or for status epilepticus. ▪ Contraindications: - medication should be avoided under the following conditions: shock, coma, depressed vital signs, obstetrical patients, and infants less than 30 days of age. - In tablet form, the medication should not be administered to infants less than 6 months of age, to patients with acute narrow-angle glaucoma or untreated open-angle glaucoma, or within 14 days of monoamine oxidase inhibitor (M A O I) therapy. ▪ Interactions Drug–Drug: - Diazepam should not be taken with alcohol or other C N S depressants because of combined sedation effects. - Cimetidine, oral contraceptives, valproic acid, and metoprolol, which potentiate diazepam’s action; and
▪ Pharmacologic Class : Hydantoin; sodium influx– suppressing drug ▪ Mechanism of action: to desensitize sodium channels ▪ Primary use: treating all types of epilepsy except absence seizures ▪ Adverse effects: C N S depression, gingival hyperplasia, skin rash, cardiac dysrhythmias, and hypotension ▪ Adverse Effects
- dysrhythmias
- severe hypotension
- hyperglycemia.
- Severe C N S reactions include headache, nystagmus, ataxia, confusion and slurred speech, paradoxical nervousness, twitching, and insomnia.
- Peripheral neuropathy may occur with long-term use.
- Phenytoin can cause multiple blood dyscrasias, including agranulocytosis and aplastic anemia.
- rashes, including exfoliative dermatitis and Stevens– Johnson syndrome. ▪ Black Box Warning: The rate of I V Dilantin administration should not exceed 50 m g/min in adults and 1–3 m g/k g/min (or 50 m g/min, whichever is slower) in pediatric patients because of the risk of severe hypotension and cardiac arrhythmias. Careful cardiac monitoring is needed during and after administering I V Dilantin. ▪ Contraindications: Patients with hypersensitivity to hydantoin products should be cautious. Rash, seizures due to hypoglycemia, sinus bradycardia, and heart block are contraindications. ▪ Drug–Drug : ▪ oral anticoagulants, glucocorticoids, antagonists, antituberculin drugs, and food supplements such as folic acid, calcium, and vitamin D. It impairs the efficacy of drugs such as digitoxin, doxycycline, furosemide, estrogens and oral contraceptives, and theophylline. When combined with tricyclic antidepressants, phenytoin can trigger seizures. ▪ Lab Tests : Phenytoin may increase serum levels of glucose, bromsulphalein, and alkaline phosphatase, and may decrease protein-bound iodine and urinary steroid levels. ▪ Herbal/Food: Herbal laxatives (buckthorn, cascara sagrada, and senna) may increase potassium loss. Ginkgo may reduce the therapeutic effectiveness of phenytoin. ▪
- Phenyton-like drugs:
- Carbamazepine (Tegretol)—tonic–clonic and partial seizures
o Use with caution with antiseizure medications, phenothiazines, and antidepressants o Pregnancy risk—pregnancy category C o Prototype drug: ethosuximide (Zarontin) ▪ Mechanism of action: suppress calcium influx ▪ Primary use: for absence seizures ▪ Adverse effects: rare but include drowsiness, dizziness, lethargy ▪ Very rare but serious side effects: systemic lupus erythematosus, aplastic anemia, agranulocytosis, pancytopenia ▪ Administration Alerts
- Do not abruptly withdraw this medication because doing so may induce tonic–clonic seizures.
- Pregnancy category C ▪ Contraindications: Hypersensitivity may occur. Do not use this medication in cases of severe liver or kidney disease. Safety in children younger than 3 years of age has not been established. ▪ Interactions
- Drug–Drug: Ethosuximide increases phenytoin serum levels. Valproic acid causes ethosuximide serum levels to fluctuate (increase and decrease). ▪ Herbal/Food: Ginkgo may reduce the therapeutic effectiveness of ethosuximide. ▪ o
- Withdrawal of Antiseizure Medications o Should be seizure-free at least three years o Withdraw gradually over several months o Resume medications if seizures return o Be aware of rebound seizures
7. Fluid and electrolytes replacement therapy ( 2-3 question)
- isotonic, hypertonic, hypotonic solutions o Hypertonic intravenous fluid Water moves from interstitial space to plasma ▪ More solutes than water ▪ Fluids will move out of the cell ▪ 5% Dextrose in 0.9% NaCl (D5 NaCl), 3% Saline, 5% saline, 10% Dextrose in water (D10W), 5% Dextrose in LR ▪ Treats: Hyponatremia, Cerebral edema, ▪ Overload can cause fluid overload and HTN. ▪ Increased in Osmolality
o Hypotonic intravenous fluid Water moves from plasma to interstitial space ▪ Have more water than solutes ▪ Fluids move into the cell ▪ 0.45% NaCl (1/2), 0.255% NaCl (1/4), 0.33% NaCl (1/3), 5% Dextrose in water (D5W) ▪ DO NOT GIVE TO INTRACRANIAL PRESSURE because will cause brain swelling; Also do not give to burn or trauma patients with hypovolemia (loss of blood/fluid volume) ▪ Treat hypernatremia and cellular dehydration, DKA ▪ Too much can cause peripheral edema or hypotension ▪ Decreased in Osmolality o Isotonic intravenous fluid No fluid shift ▪ 0.9% NS, 5% Dextrose (D5W), 5% Dextrose in 0.225% NS, Lactated Ringer’s
- colloids vs crystalloids o Crystalloids ▪ I V solutions with electrolytes ▪ Used to replace fluids and promote urine output ▪ Capable of leaving plasma and moving to interstitial spaces and intracellular fluid ▪ Compartment entered depends on tonicity of intravenous fluid ▪ Sodium is the most common added ▪ Some contain Dextrose 2.5%, 5%, and 10% for nutritional value o Colloids ▪ Molecules too large to easily cross capillary membrane ▪ Draw water from intracellular fluid and interstitial spaces into plasma (hypotonic effect) ▪ Prototype drug: dextran 40 (Gentran 40, L M D, others) ▪ Mechanism of action: to raise oncotic pressure of blood; expands plasma volume within minutes of administration ▪ Primary use: as fluid replacement with hypovolemic shock from hemorrhage, surgery, severe burns ▪ Adverse effects: hypersensitivity reactions, fluid overload, hypertension ▪ Indications include :
o High net water loss (inadequate water intake, watery diarrhea, fever, burns) o High doses of corticosteroids or estrogens
- Elevated sodium increases osmolality of plasma o Draws fluid from interstitial space and cells o Causes cellular dehydration - Signs and symptoms: o Thirst, fatigue, weakness, muscle twitching o Convulsions, altered mental status, decreased level of consciousness - Treatment of Hypernatremia o Can be treated with low-salt diet o Acute hypernatremia treated with hypotonic intravenous fluids (if hypovolemic) or diuretics (if hypervolemic)
▪ Hyponatremia Sodium level below 135 m E q/L
- Caused by excessive dilution of plasma o Excess antidiuretic hormone (A D H) secretion o Excessive administration of hypotonic intravenous solution
- Cause by: Vomiting, diarrhea, gastrointestinal suctioning, diuretic use
- Early symptoms: Nausea, vomiting, anorexia, abdominal cramping
- Later signs: Altered neurologic function such as confusion, lethargy, convulsions, coma, muscle twitching, tremors
- Hyponatremia caused by excessive dilution o Treat with loop diuretics to cause an isotonic diuresis
- Hyponatremia caused by sodium loss o Treat with oral sodium chloride or intravenous fluids containing salt ▪ Normal saline ▪ Lactated Ringer’s
- Prototype drug: sodium chloride (N a c l) o Mechanism of action: as electrolyte/ sodium supplement o Primary use: to treat hyponatremia when serum levels fall below 130m E q/L o Adverse effects: hypernatremia and pulmonary edema (when infusing hypertonic fluids) o Therapeutic Class: Drug for hyponatremia o Pharmacologic Class: Electrolyte, sodium supplement
o Actions and uses: ▪ administered for hyponatremia when serum levels fall below 130 m E q/L. ▪ Normal saline (0.9% N a C l)- used to treat mild hyponatremia. When serum sodium falls below 115 m E q/L, highly concentrated (9% N a C l) solution may be infused. ▪ Other concentrations include 0.45% and 0.22%, and both hypotonic and isotonic solutions are available. ▪ For less severe hyponatremia 1g tablets are available by P O. o Pharmacokinetics ▪ Because sodium ion is a natural electrolyte, it is not possible to obtain accurate pharmacokinetic values. o Adverse effects ▪ Patients receiving N a C l infusions must be monitored frequently to prevent symptoms of hypernatremia, which include lethargy, confusion, muscle tremor or rigidity, hypotension, and restlessness. o Contraindications: ▪ This drug should not be administered to patients with hypernatremia, heart failure, or impaired kidney function. o
- NURSING ROLES: Assess sodium and electrolyte balances, Be alert for hypo/hypernatremia, Monitor serum sodium level, urine specific gravity, serum and urine osmolarity, teach patient o Potassium ▪ Essential for proper nerve and muscle function ▪ Maintaining acid–base balance ▪ Influenced by aldosterone ▪ For each sodium ion reabsorbed, one potassium ion secreted into renal tubules ▪ Imbalances can be serious, even fatal ▪ Hyperkalemia Potassium level above 5 m E q/L
- Caused by high consumption of potassium- rich food, dietary supplements
- Risk with patient taking potassium-sparing diuretics
- Accumulates when renal disease causes decreased excretion - Signs and Symptoms: o Most serious are dysrhythmias and heart block
