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PHARMACOLOGY EXAM 1 Rasmussen
solution 2024
drugs that produce a response - ANS>> agonist drugs that prevent or block a response - ANS>> antagonist What is the therapuetic window? - ANS>> level of the drug between minimal effective concentration in the plasma for obtaining desired drug response and the minimal toxic concentration What is half life? - ANS>> The time it takes for one half of the drug concentration to be eliminated from the body is If a drug has a long half life, how often should it be taken? - ANS>> once per day What is a patient on two highly protein bound drugs at risk for? - ANS>> accumulation and toxicity What is tolerance? - ANS>> a decreased responsiveness over the course of therapy, which may lead to the need to increase dosages to attain the same effect What makes drugs fit into the same "Class" - ANS>> - related by chemical structure
- work in the same way
- used for the same purpose Before administering beta blockers, you should check what two vital signs? - ANS>> Heart rate Blood pressure Who would you not give a beta blocker to? Why? - ANS>> Asthmatic; bronchospasm What kind of drug is metoclopramide (Reglan) - ANS>> cholinergic Cholinergics do what to the body? (SLUD) - ANS>> Salivation Lacrimation Urination Defecation Anticholinergics do what to the body - ANS>> Can't see, Can't spit, Can't pee, Can't shit
Symptoms of cholinergic crisis - ANS>> Flushing, Sweating, Nausea, Abdominal cramps What drug would you give to treat cholinergic crisis? - ANS>> atropine Anticholinergics are contraindicated in which clients? - ANS>> - coronary artery disease (Increase heart rate)
- GI obstruction (constipates)
- supraventricular tachycardia (increased heart rate) CNS stimulants are contraindicated in which clients? - ANS>> - coronary artery disease (cause vasoconstriction=heart attack)
- Hypertension (additive hypertension=stroke) Most common side effects of methylphenidate (Ritalin) - ANS>> - irritability
- insomnia
- weight loss
- decreased appetite Signs of hemorrhagic stroke - ANS>> - increased B/P
- increased heart rate
- increased respiratory rate
- unresponsive to deep pain Benzodiazepines increase the activity of which neurotransmitter - ANS>> GABA Reversal agent of benzodiazepines - ANS>> Flumazenil zolpidem (Ambien) side effects - ANS>> - sedative/hypnotic (nonbenzodiazepine)
- suicidal ideation
- dependence
- abnormal behavior What is the drug of choice for treating status epilepticus - ANS>> diazepam phenytoin (Dilantin) side effects - ANS>> GINGIVAL HYPERPLASIA
- treat seizures
- cause high blood sugar
- cause birth defects
- decrease effectiveness of anticoagulants When a client is on phenytoin (Dilantin) what are some nursing interventions - ANS>> - monitor for narrow therapeutic index (frequent blood test)
- take as prescribed
- oral care
- teach pt to use barrier contraceptives along with oral
What disease process goes with "facial masking" - ANS>> Parkinsons What disease process goes with "motor neuron degeneration" - ANS>> Parkinsons What disease process goes with "neurofibillary tangles" - ANS>> Alzheimers What disease process goes with "anticholinergic drugs" - ANS>> Parkinsons Can you crush oxycontin - ANS>> NO- its extended release Can you crush iron or potassium? - ANS>> No Can you crush calcium antacids - ANS>> Yes What disease process goes with "Lack of ACh receptor sites" - ANS>> Myasthenia Gravis What disease process goes with "respiratory muscle weakness" - ANS>> Myasthenia Gravis What disease process goes with "anticholinestrase inhibitor drugs" - ANS>> Myasthenia Gravis What disease process goes with "anti-acetylcholine antibodies" - ANS>> Myasthenia Gravis What disease process goes with "immunosupressants - ANS>> myasthenia gravis and multiple sclerosis What disease process goes with "brain lesions" - ANS>> multiple sclerosis What disease process goes with "diplopia" - ANS>> multiple sclerosis What disease process goes with "spactisity" - ANS>> multiple sclerosis What disease process goes with "myelin sheath damage" - ANS>> multiple sclerosis What disease process goes with "remission/exacerbation" - ANS>> multiple sclerosis What disease process goes with "spinal cord lesions" - ANS>> multiple sclerosis Your patient is receiving treatment for myasthenia gravis with pyridostigmine (Mestonin). What should you see if it is working? - ANS>> maintenance of muscle strength
Adverse reactions pyridostigmine (Mestonin) - ANS>> life threatening dyspnea, bronchospasm, cardiac dysrhythmias, seizures Your patient is taking an MAOI and eating blue cheese, red wine with dinner? What should you tell them they are at risk for - ANS>> hypertensive crisis Patient is taking Lithium, you should advise them to avoid what other drugs - ANS>> - NSAIDS-lithium may not be processed properly
- ACE inhibitor
- HCTZ Extrapyramidal effects are most common with which class of antidepressants? - ANS>> Tricyclics Symptoms of serotonin syndrome - ANS>> Cognitive- agitation, confusion Autonomic- fever Neuromuscular- rigidity Nursing considerations with lithium - ANS>> - it has a narrow therapeutic range
- do not crush
- check serum levels**
- take same time everyday What is lithium's therapeutic range? - ANS>> 0.4-0.8mmol/L Vicodin - ANS>> contains acetaminophen Tylenol - ANS>> contains acetaminophen Lortab - ANS>> contains acetaminophen Norco - ANS>> contains acetaminophen Excedrin - ANS>> contains acetaminophen Nyquil - ANS>> contains acetaminophen Fioricet - ANS>> contains acetaminophen Percocet - ANS>> contains acetaminophen Alka seltzer plus - ANS>> contains acetaminophen What drug should not be given during an acute gout flare up - ANS>> probenicid What drug is given during an acute gout attack - ANS>> colchicine (Colcrys)
haloperidol is contraindicated in which patients? - ANS>> w/Parkinsons. Why? Because haldol is more likely to have side effects like EPS chloropromazine (Thorazine) treats which conditions - ANS>> typical antipsychotic (schizophrenia) chronic hiccups antiemetic What is the only nonsedating anti-anxiety medication - ANS>> buspirone (Buspar) How do you know a neuroleptic is working? - ANS>> Behavior decreases Typicals antipsychotics - ANS>> Work on positive symptoms Many side effects, most serious are EPS and NMS Work faster Atypical antipsychotics - ANS>> Work on both negative and positive symptoms Fewer side effects Unlikely to develop EPS but can still develop NMS *Take longer to work What is the most common side effect for both typical and atypical antipsychotics - ANS>> Drowsiness aripiprazole (Abilify) side effects - ANS>> LIFE THREATENING: suicidal ideation, NMS, agranulocytosis, neutropenia, leukopenia Why would a typical antipsychotic like haldol be given in an emergency situation? - ANS>> It works FAST buspirone (Buspar) - ANS>> non sedating anxiolytic may take up to 2 weeks to become effective NO GRAPEFRUIT JUICE lorazepam (anxiolytic) - ANS>> sedation common=no driving avoid other CNS suppressants like alcohol do not stop taking abruptly 5 cardinal signs of inflammation - ANS>> Heat Redness Swelling Pain Loss of function
What is pharmaceutics - ANS>> applies only to tablets or capsules given by mouth (PO). process in which the tablet or capsule becomes a solution, so that it can cross the biologic membrane, of the stomach or small intestine. Drugs generally disintegrate and are absorbed faster in what? - ANS>> very acidic fluids Very Old and very young people have less gastric acidity so... What is the result? - ANS>> Lower/slower absorption > Drug in the system longer If a drug is enteric coated it is meant to be absorbed in where? What would happen if you crushed it before taking it? - ANS>> Small intestine, Absorbed in stomach Pharmacokinetics - ANS>> how drugs move through body 4 processes of pharmacokinetics - ANS>> absorption, distribution, metabolism, excretion Which drugs are more easily absorbed? - ANS>> fat soluble What is the first pass effect? - ANS>> The liver can inactivate or change drugs into different forms. What is bioavailability - ANS>> the percentage of the administered dose that reaches systemic circulation Why is the bioavailability of IV drugs 100% - ANS>> Because it is administered directly into systemic circulation What factors can influence absorption of a drug? - ANS>> High fat foods increase absorption time Exercise decreases absorption because blood is in peripheral muscles and not GI tract If small intestine villi damaged, decreased absorption What is protein binding? - ANS>> Protein Binding- As drugs circulate in the blood and plasma, some of them have a high affinity for binding to the plasma proteins. Drugs that are stuck onto the proteins, aren't free to go to their target receptor sites and do their jobs. What happens when two protein bound drugs are given together? - ANS>> Compete for binding sites on protein. One with lesser affinity will be more abundant in blood If a patient is on two highly protein bound drugs it can lead to _________ and ___________ - ANS>> accumulation, toxicity
aged cheese, blue cheese, cured meat, summer sausage, pepperoni, salami, smoked/processed meats, pickled foods, sauces, soybeans, pop peas, dried fruit, meat tenderizers, yeast, alcoholic foods OTC cough and cold remedies don'ts - ANS>> Most contain sympathomimetics... these products should not be taken by patients with hypertension or thyroid disease without consulting their health care provider Autonomic nervous system - ANS>> Sympathetic (fight or flight) or parasympathetic (rest and digest) Sympathetic nervous system - ANS>> - norepinephrine
- receptors alpha 1 & 2, Beta 1 & 2
- fight or flight Parasympathetic nervous system - ANS>> - acetylcholine
- Receptors: nicotinic, muscarinic
- rest or digest Adrenergic agonists are also known as - ANS>> adrenergics sympathomimetics Effects of adrenergic agonists - ANS>> Increased BP. Increased HR, Bronchodilation, Increases Blood Sugar, Pupil Dilation, Alertness Name two adrenergic agonist drugs - ANS>> epinephrine, albuterol Catecholamine is the other name for this neurotransmitter - ANS>> epinephrine, norepinephrine Beta blockers action - ANS>> specifically block beta receptor sites; also inhibit the release of norepinephrine and epinephrine. Beta blockers effects - ANS>> depression, sexual dysfunction, cool extremities, bronchoconstriction What do beta blockers treat? - ANS>> hypertension, migraine prophylaxis, angina, myocardial infarction, heart failure. Side effects of beta blockers - ANS>> depression, sexual dysfunction, cool extremities Cholinergic agonists aka - ANS>> chlonergics parasympathomimetics Direct acting cholinergics - ANS>> act on receptors to activate a tissue response
Indirect acting cholinergics - ANS>> inhibit the action of the enzyme cholinesterase, permitting ach to persist and attach to the receptor Effects of cholinergics - ANS>> stimulates urination, increases salvation and tear production, increases GI peristalsis Name two cholinergic drugs - ANS>> Bethanacol chloride (urecholine), Metoclopramide hcl (Reglan) bethanecol chloride (Urecholine) - ANS>> increases urination pilocarpine (Salagen) - ANS>> increases salivation What causes myasthenia gravis - ANS>> lack of Ach receptor sites, leads to lack of nerve impulses You will see antiacetylcholine antibodies in people with this disease - ANS>> myasthenia gravis Anticholinergics aka - ANS>> cholinergic antagonists parasympatholytics Anticholinergic drugs - ANS>> - Atropine- for bradycardia, reduces salivation, dilates pupils
- Benztropine- Parkinsons
- Telterodine Tartate- decreases urinary frequency, urgency, incontinence Use caution when giving anticholinergics in patients with these conditions - ANS>> glaucoma, urinary retention WHY glaucoma- inhibit the ability of the eye to excrete fluid, increases intraocular pressure anticholinergics cause urinary retention so this exacerbates the problem Amphetamines - ANS>> stimulates the release of the norepinephrine and dopamine from the brain and sympathetic nervous system Common side effects of amphetamines - ANS>> insomnia, restlessness, nervousness, tremors, irritability, tachycardia, hypertension, weight loss methylphenidate (Ritalin) dexmethylphenidate (Focalin) What do they treat? - ANS>> ADHD, narcolepsy phetermine - ANS>> used for short term treatment of obesity causes CNS stimulation
Treatments for Parkinsons - ANS>> anticholinergics, dopamine replacements, dopamine agonists, MOA-B inhibitors, COMT inhibitors carbidopa/levodopa (sinemet) - ANS>> Levodopa is converted to dopamine before it reaches the brain, this combination ensures more dopamine reaches the brain carbidopa/levodopa side effects - ANS>> GI upset Dyskinesia (impaired voluntary movement) Orthostatic hypotension Alzeheimers disease - ANS>> incurable dementia by chronic, progressive neurodegerative conditions with marked cognitive dysfunction Alzheimers symptoms - ANS>> memory loss, confusion, inability to communicate, aggressive behavior, depression rivastigmine (Exelon) donepezil (Aricept) treat what? - ANS>> Alzheimers Action of rivastigmine (Exelon) , donepezil (Aricept) - ANS>> Prevent breakdown of acetylcholine, permitting more acetylcholine to interact with recpetors This increases neuron transmission and improves cognitive function Side effects of rivastigmine (Exelon) - ANS>> renal and hepatotoxicity suicidal ideation Stevens Johnson syndrome Myasthenia gravis - ANS>> a lack of nerve impulses & muscle responses at nerve and muscle junctions; autoimmune disease. Treatment= Anticholinesterase inhibitors Myasthenic crisis - ANS>> EMERGENCY Not enough acetylcholine, severe generalized weakness, may involve respiration muscles Cholinergic crisis - ANS>> EMEREGENCY TOO much acetylcholine. Symptoms: muscle weakness,, increased salivation. Treatment: Atropine (anticholinergic) Multiple sclerosis - ANS>> Autoimmune disorder that attacks the myelin sheath of nerve fibers in the brain and spinal cord, causing lesions called plaques Multiple sclerosis treatments - ANS>> Glucocorticoids
Biological immune modifiers immunosuppressant cyclophosphamide cyclobezaprine (Flexeril) is used to treat what - ANS>> multiple sclerosis cyclobenzaprine (Flexeril) side effects - ANS>> DROWSINESS anticholinergic effects dizziness headaches What should you teach patients taking cyclobenzaprine (Flexeril) - ANS>> No driving No alcohol Multiple sclerosis symptom management - ANS>> Skeletal Muscle Relaxer (Diazepam, Baclofen, Tizanidine, Methacarbamol) Histamine - ANS>> causes dilation of arterioles & increases capillary permeability, allowing fluid into the injured areas Kinins - ANS>> such as bradykinin increases capillary permeability & the sensation of pain Prostaglandins - ANS>> increase vasodilation, capillary permeability, pain & fever aspirin - ANS>> NSAID decreases inflammation, decreases platelet aggregation, higher doses are usually enteric coated to protect the stomach Nursing considerations aspirin - ANS>> observe patient for signs of bleeding do not take with alcohol, other highly protein bound drugs do not give to children potential for hypersensitivity aspirin hypersensitivity (salicyclism) manifests as - ANS>> tinnitus vertigo bronchospasm COX1 - ANS>> specific for protecting gastric mucosa lining, blood clotting (platelet aggregation) COX2 - ANS>> specific for pain, inflammation, fever COX2 specific meds treat - ANS>> pain, inflammation, fever If taking a nonspecific COX inhibitor - ANS>> both COX1 and COX2 inhibited SO: GI bleeding, blood thinning, reduce pain, fever, inflammation
prevents acute attacks Gout: urosurics - ANS>> probenicid (Probalon) promotes uric acid excretion do not give during acute attack Patient education GOUT - ANS>> INCREASE fluid intake to promote uric acid excretion Keep lab appointments What is analgesia - ANS>> relief from pain What is used to relieve mild to moderate pain - ANS>> nonopioid analgesics What is used to treat moderate to severe pain - ANS>> opioid analgesics Nonopioid analgesics - ANS>> aspirin ibuprofen ketorolac** COX2 inhibitors acetaminophen ****naproxen*** Is acetaminophen (APAP) an NSAID/antiinflmmatory) - ANS>> NO! acetaminophen (APAP) - ANS>> analgesic antipyretic (FEVER) safe when used in therapeutic doses Nursing considerations acetaminophen - ANS>> CAN CAUSE HEPATOTOXICITY do not exceed 3g per day Patient education acetaminophen - ANS>> check labels and take only one drug containing acetaminophen at a time limit to 3000mg/3g per day People with gout should avoid what kinds of food? - ANS>> high in purine Examples of high purine food - ANS>> Alcohol Fish Meats most processed foods What are purines broken down into? - ANS>> uric acid ketorolac (Toradol) - ANS>> NSAID
Analgesic & anti-inflammatory commonly given IV & IM treats moderate to severe pain not to exceed 5 days total treatment ketorolac can cause what? - ANS>> fetal abnormalities in first trimester of pregnancy Opioid analgesics - ANS>> - act primarily on MU receptors of the CNS
- Suppress pain impulses
- suppress respiration
- suppress cough
- antidiarrheal effects morphine sulfate adverse reactions - ANS>> life threatening respiratory depression (all opioids) (check it)
- increased intracranial pressure* (check it)
- hypotension* (check it)
- seizures
- constipation
- paralytic ileus The half life of Naloxone is shorter than the half life of most opioids meaning what? - ANS>> may need to have a second dose of naloxone buprenorphine/nalaxone (Suboxone) - ANS>> - combination opioid and opioid antagonist
- Used to help pts taper off heroin or other opioid drugs when addicted.
- If the pills are crushed for snorting or injecting, the naloxone capsules break open and cancel out the opioid effects at the receptor sites. Migraines - ANS>> - caused by inflammation and dilation of the blood vessels in the cranium. Drugs: beta blockes, anticonvulsants, antidepressants, triptans, NSAIDS/naproxen sumatriptan (Imitrex) - ANS>> rescue drug for migraine attack causes vasoconstriction of craniala rteries sumatriptan (Imitrex) adverse effects - ANS>> LIFE THREATENING coronary artery spasm MI cardiac arrest Bipolar - ANS>> A brain disorder that causes unusal shifts in mood, energy, activity levels, and the ability to carry out daily tasks.
Tricyclic antidepressants action - ANS>> increase levels of serotonin and norepinephrine in brain and blocks acetylcholine You should monitor any patient with psycholoical issues for - ANS>> suicidal ideation What is the treatment for suspected tricyclic overdose? - ANS>> sodium bicarbonate need EKG and cardiac monitoring amitriptyline side effects - ANS>> sedation, fatigue, hypotension, anticholinergic effects, cariotoxicity, cardiac arrest, seizures Name a MAOI - ANS>> tranylcypromine (Parnate) Regular monitoring of what vital sign is essential for patients taking MAOIs (tranlcypromine (Parnate)) - ANS>> blood pressure Patients taking MAOIs should be educated to avoid the following (tranlcypromine (Parnate)) - ANS>> CNS stimulants or sympathomimetics TYRAMINE FOODS A hypertensive crisis increases the risk of - ANS>> hemorrhagic stroke Action of MAOIs (tranlcypromine (Parnate)) - ANS>> inhibits actions of monamine oxidase which breaks down all 4 neurotransmitters this increases presence of neurotransmitters in entire body Name an SSRI - ANS>> fluoxetine (Prozac) fluoxetine (Prozac) - ANS>> - takes 1 to 4 weeks for effects
- monitor for suicide ideation
- limit grapefruit juice Name an SNRI - ANS>> venlafaxine (Effexor) If this antidepressant is taken with St. John's wart, it substantially increases life threatening serotonin syndrome and neuroleptic malignant syndrome - ANS>> venlafaxine (Effexor) With any antidepressant, which lab value should we monitor? - ANS>> liver values What can cause serotonin syndrome? - ANS>> when you take medication that causes high levels of the chemical serotonin to accumulate in your body (typically with use of more than one antidepressant) Why is it essential to administer carbidopa/levidopa within a 30 minute window of administration time? - ANS>> Client will experience ABRUPT return of symptoms
Nicotinic receptors - ANS>> parasympathetic effect skeletal muscles Muscarinic receptors - ANS>> parasympathetic stimulate smooth muscle slows HR What is epinephrine used to treat? - ANS>> allergy, anaphylaxis, asthma, cardiac arrest, severe hypotension What is albuterol used to treat? - ANS>> bronchoconstriction associated with asthma and COPD adrenergic=adrenergic response Adverse effects albuterol, epineprhine - ANS>> adrenergic antagonist effects What does atropine do? - ANS>> atropine is gasoline- increases heart rate, decreases salivation, dilates pupils Treats bradycardia. reduces salivation, dilates pupils for eye exam Sleep aid don'ts - ANS>> Contain ANTIHISTAMINES should not be taken with CNS depressant medications due to increased CNS depression. After a pill is taken by mouth, what organ has a major impact on its bioavailability? - ANS>> liver If a patient has liver disease, will that affect the amount of drug that ends up in systemic circulation? In what way? - ANS>> Yes, it will increase the amount of drug that ends up in systemic circulation If the kidneys aren't filtering the drug out, what is happening to it? - ANS>> It is accumulating If there is renal (kidney) impairment what would you expect would have to be done with the drug dosing? - ANS>> Lowered dosing If either the peak or trough is too high, what can occur? - ANS>> Toxicity What are adverse reactions? - ANS>> Unintended and unwanted effects, which can occur even at normal doses. Must always be reported and documented, as they represent variances from the planned therapy.
