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Krystan: Semester Two Nursing School > 2820 Pharmacology Exam Four > Flashcards

2820 Pharmacology Exam Four Flashcards

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1
Q

haloperidol: therapeutic use

A

acute and chronic psychotic disorders

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2
Q

why is haloperidol often used at the end of life?

A

because some patients develop agitation and delirium as they near death

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3
Q

lorazepam: action

A

potentiates the effect of GABA to reduce neuronal excitability

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4
Q

why might lorazepam be administered as patients approach death?

A

because patients nearing death may become anxious and restless due to dyspnea, pain, etc.

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5
Q

lorazepam: class

A

sedative hypnotic

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6
Q

ondansetron/zofran: action

A

blocks serotonin receptors in GI tract and the chemoreceptor trigger zone in the brain

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7
Q

why might zofran be given in the end of life process?

A

to help with nausea and vomiting (often due to pain, fear, or the side effects of other drugs)

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8
Q

what are adverse effects associated with zofran?

A 
headache
dizziness
drowsiness
constipation 
diarrhea
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9
Q

why is constipation often an issue at the end of life?

A

not eating well
lack of mobility
side effect of other medications

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10
Q

action of bulk forming laxatives

A

contain fiber to absorb water and increase the size of the fecal mass

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11
Q

why must patients drink plenty of water with bulk forming laxatives?

A

because there has to be enough water in the system for the drugs to pull it into the colon

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12
Q

saline cathartics are also known as

A

osmotic laxatives

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13
Q

how do saline cathartics work?

A

they pull water into the fecal matter to create more watery stool

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14
Q

why should saline cathartics not be used on a regular basis?

A

they can produce very rapid bowel movements, leading to dehydration and electrolyte imbalance

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15
Q

how do stimulant laxatives work?

A

they promote peristalsis by irritating bowel mucosa

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16
Q

surfactant laxatives are also known as

A

stool softeners

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17
Q

how do surfactant laxatives work?

A

they cause more water and fat to be absorbed into the stool to make it softer

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18
Q

what are surfactant laxatives most often used for?

A

preventing constipation in patients who recently had surgery or are at higher risk for constipation

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19
Q

how do herbal agents such as senna work in managing constipation?

A

they irritate the bowel to increase peristalsis

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20
Q

when is morphine often given to help with dyspnea?

A

when dyspnea is due to heart failure, pulmonary edema, or during the end of life process

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21
Q

why is it theorized that morphine helps with dyspnea?

A

not fully understood, but might be due to it vasodilating pulmonary vasculature

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22
Q

why is secretion control important during end of life processes?

A

because patients have increased secretions and decreased coughing and swallowing to deal with them

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23
Q

scopolamine: class

A

anticholinergic

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24
Q

why is scopolamine effective in controlling secretions?

A

it blocks cholinergic responses (such as salivation and bronchial secretions) allowing sympathetic responses to dominate

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25
Q

What happens when penicillin weakens the bacterial cell wall?

A

It allows water to enter, killing the organism

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26
Q

What type of bacteria are most commonly affected by penicillins?

A

Gram positive (streptococcus and staphylococcus)

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27
Q

What are some infections for which penicillin is indicated?

A

Pneumonia
Meningitis
Skin, bone, joint, stomach, blood, and heart valve infections

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28
Q

What are two broad spectrum antibiotics?

A

Ampicillin and amoxicillin

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29
Q

What is the primary advantage of extended-spectrum antibiotics like piperacillin?

A

Activity against Pseudomonas auruginosa, which causes many HAIs and can be hard to treat

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30
Q

Why is penicillin G only given IV or IM?

A

It is poorly absorbed (only 15%) if given orally

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31
Q

What is the most serious adverse effect of penicillin G?

A

Anaphylaxis

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32
Q

What effect does penicillin G have on oral contraceptives?

A

Decreases effectiveness

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33
Q

What is the primary use of cephalosporins?

A

Gram negative bacteria or for use in patients who cannot tolerate less expensive penicillins

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34
Q

How are cephalosporins classified?

A

By generations (first through fifth generation)

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35
Q

Examplar cephalosporin

A

Cefazolin (ancef)

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36
Q

What cases or infections call for the use of cefazolin?

A

Respiratory, urinary, skin, biliary tract, bone, or joint infections
Also commonly used prophylactically before surgery

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37
Q

Why is cefazolin one of the most frequently prescribed parenteral antibiotics?

A

Longer half life, so less frequent dosing is necessary

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38
Q

What is a primary contraindication for cefazolin?

A

Previous severe allergic reaction to penicillin

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39
Q

What do carbapenems do?

A

Inhibit bacterial cell wall construction

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40
Q

Carbapenem exemplar drug

A

Imipenem

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41
Q

Why is imipenem the most widely prescribed carbapenem?

A

It has the broadest antimicrobial spectrum of any antibiotic

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42
Q

What is imipenem always combined with and why?

A

Cilastatin to increase serum levels of the dose

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43
Q

What types of infection is vancomycin reserved for?

A

Severe gram positive infections

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44
Q

Which bacterial infection is vancomycin most effective in treating?

A

MRSA

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45
Q

What is a serious adverse effect of vancomycin?

A

Ototoxicity

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46
Q

What lab work is done after three doses of vancomycin?

A

Peak and trough doses

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47
Q

What reaction can occur with rapid IV administration of vancomycin?

A

Red man syndrome (large amounts of histamine released)

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48
Q

What are common signs and symptoms of red man syndrome?

A 
Hypotension
Flushing
Red rash
Increased heart rate 
N/V
Dizziness
Fainting
Muscle weakness
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49
Q

What is the mechanism of action for tetracyclines?

A

Binding to bacterial ribosomes to slow microbe growth and exert a bacteriostatic effect

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50
Q

Why is therapeutic utility of tetracyclines limited?

A

Many bacterial strains are now resistant to it because it used to be very widely prescribed

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51
Q

Why should PO tetracyclines not be taken with milk or iron supplements?

A

They bind metals like calcium and iron, which can decrease absorption by up to 50%

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52
Q

What dermatological manifestation can occur with tetracyclines?

A

Severe photosensitivity

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53
Q

Why should patients younger than eight not be given tetracyclines unless absolutely necessary?

A

May cause permanent yellow-brown discoloration of teeth

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54
Q

What is the first macrolide antibiotic?

A

Erythromycin

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55
Q

For what illnesses is a macrolide indicated?

A

Whooping cough
Legionnaires disease
H. Influenza
M. Pneumoniae

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56
Q

For which infection is fidaxomicin specifically approved?

A

C. Diff

57
Q

What types of infections are aminoglycosides reserved for? Give an example

A

Serious systemic gram negative infections like e. Coli

58
Q

Why are aminoglycosides given parenterally?

A

They are poorly absorbed from the GI tract

59
Q

For what types of infections are gentamicin given?

A

Serious urinary, respiratory, nervous, or GI infections

60
Q

What are four serious adverse effects that gentamycin can cause?

A

Neurotoxicity
Neuromuscular blockade
Respiratory paralysis
Nephrotoxicity

61
Q

Why must patients take antitubercular drugs for 6-12 months?

A

Because the microorganisms are very slow growing and it takes that long for the meds to reach the microorganisms isolated in the tubercules

62
Q

What is the most effective way to ensure adherence to antitubercular drugs?

A

Directly observed therapy

63
Q

Why is multiple drug therapy necessary for mycobacterium infections?

A

Resistance is common and mycobacterium grow slowly

64
Q

When is chemoprophylaxis for TB indicated?

A

Close contact with actively infected patients or for susceptible immunocompromised patients

65
Q

What is an example of an antitubercular drug?

A

Isoniazid (INH)

66
Q

Why is isoniazid a first line drug to treat TB?

A

High safety profile and very effective

67
Q

When should isoniazid be administered?

A

On an empty stomach (either one hour before or two hours after a meal)

68
Q

What serious adverse issue can isoniazid cause?

A

Hepatotoxicity

69
Q

What are some signs of hepatotoxicity?

A

Jaundice
Fatigue
Increased liver enzymes
Appetite loss

70
Q

What is amphotericin B?

A

An anti fungal drug

71
Q

What types of infections is amphotericin used for?

A

Serious systemic fungal infections

72
Q

By what route is amphotericin given?

A

IV

73
Q

Why must amphotericin be given slowly?

A

Risk of cardiovascular collapse if infused slowly

74
Q

What adverse effects may patients experience at the beginning of treatment with amphotericin B?

A

Fever, chills, vomiting, and headache, but will go away as treatment is continued

75
Q

In what areas do protozoal/non-malarial infections occur most frequently?

A

Those with poor public sanitation and high population density

76
Q

What is a common antiprotozoal drug?

A

Metronidazole (flagyl)

77
Q

What are indications of use for metronidazole?

A

Nonmalarial protozoal infections (amebiasis, giardiasis, trichomoniasis)
Respiratory, bone, skin, and CNS infections (also has antibiotic properties)

78
Q

What adverse effects of metronidazole could impact a patients nutrition?

A

Dry mouth and metallic taste in mouth

79
Q

What is the black box warning for metronidazole?

A

It is carcinogenic in lab animals

80
Q

What infections make up the herpesvirus family?

A 
HSV 1
HSV 2
CMV
Varicella-zoster virus 
Epstein Barr 
Herpesvirus type 6
81
Q

What occurs following initial entrance of a herpesvirus into the body?

A

It may remain latent for many years

82
Q

What conditions can promote replication of a herpesvirus?

A

Immunosuppression
Physical challenges
Emotional stress

83
Q

What is an exemplar drug in the antiviral family?

A

Acyclovir

84
Q

Against which infections is acyclovir most effective?

A

HSV 1 and 2

In larger doses, CMV and varicella-zoster

85
Q

How does acyclovir decrease duration and severity of acute herpes episodes?

A

It prevents viral DNA synthesis (but does not cure the patient)

86
Q

what is the general action of psychotropic medications?

A

either increasing or decreasing the activity of certain neurotransmitters

87
Q

what are the four levels of anxiety?

A

mild
moderate
severe
panic

88
Q

alprazolam and clonazepam: class

A

benzodiazapines

89
Q

alprazolam/clonazepam: action

A

enhances the effects of GABA in the CNS (inhibits CNS)

90
Q

alprazolam/clonazepam: use

A

rapid relief of anxiety in anxiety disorders

91
Q

alprazolam/clonazepam: adverse effects

A 
amnesia
sedation/drowsiness/lethargy
paradoxical effect
dependence
toxicity
92
Q

what should patients be advised to not use with alprazolam or clonazepam?

A

alcohol
opioids
grapefruit juice
CNS depressants

93
Q

nursing considerations for alprazolam/clonazepam?

A

for short term use only due to dependence risk
monitor for toxicity and paradoxical response
initiate fall precautions

94
Q

paroxetine: class

A

SSRI

95
Q

paroxetine: action

A

selectively inhibits serotonin receptors to increase serotonin levels

96
Q

paroxetine: use

A 
long term treatment of anxiety disorder 
OCD
panic disorder
depression 
PTSD
97
Q

how long does it take for paroxetine to reach full therapeutic effects? why?

A

4 weeks because it has a very long half life

98
Q

paroxetine: adverse effects

A 
sexual dysfunction
insomnia
somnolence
headache 
nervousness
serotonin syndrome
suicidal ideation
drowsiness
99
Q

nursing considerations for paroxetine

A 
give with food
monitor for suicidal thoughts or actions, especially at start of treatment
take in morning to prevent insomnia
monitor for serotonin syndrome
do not discontinue suddenly
100
Q

what is a benefit of SSRI’s over TCAs?

A

less anticholinergic and cardiac effects

101
Q

citalopram: class

A

SSRI

102
Q

how long can citalopram take to reach full effectiveness? why?

A

1-3 weeks due to long half life

103
Q

citalopram: use

A 
generalized anxiety disorder
major depressive disorder/other depressive disorders
PTSD
OCD
bulimia 
panic and social anxiety disorder
104
Q

citalopram: adverse effects

A 
sexual dysfunction
serotonin syndrome
insomnia
headache
nervousness
suicidal ideation
drowsiness
105
Q

citalopram: nursing considerations

A

don’t discontinue suddenly (taper dose slowly)
monitor for serotonin syndrome and suicidal ideation
give in the morning
avoid caffeine

106
Q

how soon after dosing can serotonin syndrome occur?

A

between 2-72 hours, but usually occurs at around 24 hours

107
Q

what are some signs and symptoms of serotonin syndrome?

A 
agitation/restlessness
confusion
increased HR and BP
dilated pupils
muscle twitching or lack of muscle control
muscle rigidity
fever
sweating
diarrhea
fever
seizures
shivering
108
Q

venlafaxine: class

A

SNRI

109
Q

venlafaxine: action

A

blocks the reuptake of serotonin and norepinephrine at the synaptic space, leaving more at the neuron junction

110
Q

venlafaxine: use

A

major depressive disorder (primary)

also panic disorders and can be used as adjuvant pain medication

111
Q

venlafaxine: adverse effects

A 
bizarre dreams
sweating
loss of appetite and weight loss
serotonin syndrome
dry mouth
n/v
112
Q

venlafaxine: nursing considerations

A

taper slowly when discontinuing
administer in the morning
avoid caffeinated beverages
monitor for serotonin syndrome and other side effects

113
Q

trazadone: class

A

atypical antidepressant

114
Q

trazadone: action

A

alters effect of serotonin in CNS

115
Q

trazadone: use

A

major depression
alternative for patients who cannot tolerate SSRIs/SNRIs
smoking cessation

116
Q

trazadone: adverse effects

A 
headache
dry mouth
drowsiness
serotonin syndrome
GI distress/constipation
insomnia
BP changes
117
Q

trazadone: nursing considerations

A

taper slowly
monitor for serotonin syndrome
do not take with alcohol

118
Q

amitriptyline: class

A

tricyclic antidepressant

119
Q

amitripyline: action

A

blocking reuptake of serotonin and norepinephrine

120
Q

amitriptyline: use

A

major depression
depressive episodes of bipolar
fibromyalgia and neuropathic pain
anxiety and OCD

121
Q

amitriptyline: adverse effects

A

anticholinergic effects
hypertension
toxicity
decreased seizure threshold

122
Q

amitriptyline: contraindications

A

past history of MI, asthma, GI disorders, or alcoholism

123
Q

amitriptyline: nursing considerations

A

monitor BP and HR

tell client to avoid alcohol and other CNS depressants

124
Q

lithium: class

A

mood stabilizer

125
Q

lithium: action

A

producing neurochemical changes in the brain, including serotonin receptor blockade

126
Q

lithium: use

A

control of acute manic episodes in bipolar

prevention of return of mania or depression in bipolar

127
Q

lithium: adverse effects

A 
GI distress
fine hand tremors
polyuria
thirst
weight gain
renal toxicity
hypothyroidism
hypotension
hyponatremia
lithium toxicity
128
Q

what does lithium act like in the body?

A

a salt

129
Q

lithium: nursing considerations

A

administer with milk or food
limit caffeine
maintain adequate fluid and sodium intake
monitor thyroid hormone levels
monitor lithium levels (narrow therapeutic index)
healthy diet/weight control

130
Q

valproic acid: class

A

mood stabilizer/antiepileptic

131
Q

valproic acid: action

A

slows entrance of sodium and calcium back into cell
potentiates effects of GABA
inhibits glutamate to suppress CNS

132
Q

valproic acid: use

A

treats and prevents relapse of mania and depression in bipolar disorder

133
Q

valproic acid: adverse effects

A 
dizziness
ataxia
somnolence
headache
blurred vision
drowsiness
prolonged bleeding
hepatotoxicity
pancreatitis
134
Q

valproic acid: nursing considerations

A 
monitor amylase
monitor liver enzymes
monitor platelet counts
watch for weight gain
administer at bedtime
should not be taken in pregnancy
135
Q

definition of physical dependence

A

a state in which abstinence syndrome will occur if use is discontinued

136
Q

tolerance

A

particular dose of a drug eliciting less of a response due to repeated use of a drug

137
Q

addiction

A

a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences.

138
Q

psychological dependence

A

intense subjective need for a particular psychoactive drug

Krystan: Semester Two Nursing School (13 decks)

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