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Pharmacology 1 > exam 2 > Flashcards

exam 2 Flashcards

1
Q
  1. Centrally acting skeletal muscle relaxants include which meds?
  2. What do these treat?
  3. Adverse effects?
  4. Contraindications:
  5. Cautions:
  6. drug to drug interactions:
  7. what special instructions are there for stopping the use of baclofan?
A
  1. baclofen (Lioresal) and carisoprodol (Soma)
  2. muscle spasticity and spinal cord diseases
  3. SEIZURES, drowsiness, dizziness, nausea, weakness, urinary frequency, hypotension,
  4. allergy
  5. epilepsy, cardiac dysfunction, hepatic/renal dysfunction, pregnancy/lactation
  6. alcohol and CNS depressants
  7. slowly taper use over 1-2 weeks to avoid psychoses and hallucinations
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2
Q
  1. Which part of the brain coordinates intentional muscle movements?
  2. Which part of the brain coordinates involuntary muscle activity?
A
  1. cerebellum, pyramidal tract

2. cerebellum and basal ganglia, extrapyramidal tract

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3
Q
  1. What are 2 drugs that are direct-acting skeletal muscle relaxants?
  2. How does dantrolene work?
  3. what is dantrolene indicated for?
  4. What is dantrolene’s adverse effects?
  5. Contraindications:
A
  1. dantrolene (Dantrium), and Botox
  2. it Interfers with release of calcium preventing fibers from contracting
  3. management of upper motor neuron- associated muscle spasm like, myasthenia gravis, spinal cord injury, MS, cerebral palsy, and malignant hyperthermia
  4. Rash, urinary frequency, weakness, hepatitis, tachycardia. TOXIC to liver!
  5. known allergy and active hepatic disease. TOXIC to liver
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4
Q
  1. What are the goals of general anesthesia?

2. The nurses job with general anesthesia is monitoring the patient for which adverse effects?

A
  1. analgesia, unconsciousness, and amnesia
2. Respiratory depression
Bronchospasm
Slowed GI activity
Hypotension
Malignant hyperthermia
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5
Q
  1. What is balanced anesthesia?
  2. What types of drugs are included in balanced anesthesia?
  3. name a few types of anesthetics and an example of each.
A
  1. use of several different types of drugs to acheive anesthesia w/ fewest adverse effects
  2. pre-op meds, sedatives, antihistamines, antiemetics, and narcotics
  3. Barbituates: methohexital (Brevital), Non-barbituates: midazolam (in the benzodiazepine classification), Gasses: nitrous oxide, and Volatile liquids ending in “ane”
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6
Q
  1. What are the different methods of local anesthesia?
  2. Give an example of a local anesthetic? What 2 classifications of local anesthetics are there?
  3. What should the nurse observe for in patients under local anesthesia?
A
  1. topical, infiltration (injecting directly into the tissue), field block (more widespread than infiltration. used in dental work), nerve block (peripheral, spinal, central, epidural, and caudal)
  2. Lidocaine. Locals often end in “aine”. Two classifications are esters and amides (lidocaine is an amide).
3. Local reactions
Hypotension
Incontinence
Pruritus
Seizures
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7
Q
  1. What do neuromuscular junction blocking agents do?
  2. How do these agents break down?
  3. T or F we use neuromuscular blocking agents in intubation?
  4. What dangerous adverse reaction can happen with use of these agents?
  5. what is the prototype?
A
  1. prevent muscla contraction by attaching to ACh receptor sites causing long depolarizaion (inability to contract)
  2. slowly break down in the body by cholinesterase (cirrhosis, burns, cancer patients might have limited cholinesterase)
  3. T but ventilation must be artificially supported
  4. malignant hyperthermia
  5. succinylcholine
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8
Q
  1. What are the 9 categories of antibiotics?

2. What are the 5 types of adverse reactions that antibiotics usually cause?

A
  1. aminoglycosides, glycopeptides (vanco), B-lactams (penicillins), fluoroquinolones, Macrolides, lincosamides, sulfonamides, Oxazolidinones, and misc. like tetracyclines and metronidazole
  2. kidney damage, GI toxicity, Neurotoxicity, Hypersensitivity reactions, and superinfections
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9
Q
  1. What is selective toxicity?
  2. In what 3 ways is selective toxicity achieved?
  3. Which type are more serious Gram positive or Gram negative?

4, What are the main nursing responsibilities around antibiotic treatment?

A
  1. the ability to suppress microbial growth without injury to the host.
  2. disruption of bacterial cell wall, inhibition of an enzyme unique to the bacteria, and disruption of bacterial protein synth.
  3. G neg.
  4. watch for allergies, watch organ systems affected by drug, contraindications, lab values, educating client, evaluate effectiveness, and have client report super
    infections.
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10
Q
  1. What is the prototype drug for aminoglycosides? What is their suffix and for what are they indicated?
  2. Mechanism of action:
  3. contraindications:
  4. Administration:
  5. Adverse effects:
  6. What should not be taken with this?
A
  1. Gentamicin. Suffix: “mycin” Serious infections and G neg.
  2. inhibition of bacterial protein synth
  3. allergy, renal or hepatic disease, or hearing loss.
  4. IV or IM
  5. ototoxicity, nephrotoxic (monitor urine output 30mL/hr to ensure kidney function)
  6. diuretics, neuromuscular blockers, succinylcholine, citrate, or anticoagulated blood
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11
Q
  1. What is the prototype for Lipoglycopeptides (Glycopeptides)? For what is it indicated?
  2. Administration?
  3. Adverse effects:
  4. What special instructions must be followed when administering this medication?
A
  1. Vancomycin. MRSA and penicillin allergy
  2. Inhbits cell wall synth
  3. IV- slowly over 1 hour or “red man” syndrome can occur
  4. highly nephrotoxic - measure peak and trough
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12
Q
  1. What is the prototype drug for B-Lactam and what is it indicated for? What is/are its suffixes?
  2. What is its mechanism of action?
  3. Contraindications:
  4. Adverse effects:
  5. Drug to drug:
A
  1. Penicillin. Indicated for severe infections. Broad spectrum use. Suffix is “cillin” or “pen” (Pfizerpen)
  2. Interferes with bacterial cell wall synthesis
  3. allergies to cephalosporins, renal disease. Caution in pregnancy and lactation
  4. GI discomfort
  5. tetracyclines, parenteral aminoglycosides
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13
Q
  1. What is the prototype Carbapenem?
  2. Mechanism of action:
  3. Contraindications:
  4. Adverse effects:
  5. Drug to drug:
A
  1. Imipenem
  2. inhibit cell membrane synthesis
  3. allergy to B-Lactams, seizure disorders, meningitis, pregnancy and lactation.
  4. Pseudomembranous colitis, C-diff, nausea, vomiting, dehydration, superinfections
  5. Valproic acid, Meropenem
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14
Q
  1. What group of antibiotics are a chemical modification to the penicillin structure?
  2. How many generations are there of this drug, and give a couple examples:
  3. Contraindications:
  4. Adverse effects:
  5. Drug to drug:
A
  1. Cephalosporins
  2. 4 Generations: 1st Keflex, 2nd Ceclor, 3rd Omnicef etc…
  3. penicillin allergies, hepatic and renal impairment
  4. GI issues, C-diff, superinfections (esp 3rd gen)
  5. Disulfuram reaction if mixed w/ alcohol. Aminoglycosides, oral anticoagulants, ETOH
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15
Q
  1. What is the prototype drug of Fluoroquinolones? What is their suffix? What are they indicated for?
  2. What is their mechanism of action?
  3. Contraindications:
  4. Adverse reactions:
  5. Drug to drug:
A
  1. Ciprofloxacin. “cin”. Gram negative infections of the urinary/respiratory tract, ear, eye, bone, skin infections. Anthrax exposure, typhoid fever
  2. Interferes w/ DNA replication in gram negative
  3. children, pregnancy, lactation, renal dysfunction
  4. tendon rupture, headache, dizziness, insomnia, depression
  5. Antacids (because of aluminum), quinidine, theophylline, heightened Warfarin effect
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16
Q
  1. Macrolides are similar to ………….. . Which one is more toxic?
  2. Name a prototype macrolide: Lincosamide:
  3. The mechanism of action for both types:
  4. Adverse effect:
  5. Macrolides are contraindicated for:
A
  1. Lincosamides. Lincosamides are more toxic.
  2. Macrolides: Erythromycin, Azithromycin. Lincosamides: Clindamycin
  3. Inhibit protein synthesis for G+ and G-
  4. Pseudomembranous colitis, Clindamycin can cause C-diff,
  5. heart problems because of QT prolongation
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17
Q
  1. Which semisynthetic antibiotic is based on the structure of a common soil mold?
  2. Mechanism of action:
  3. Which drug does this commonly replace when someone has an allergy? What is a common indication?
  4. Contraindications:
  5. Important to remember with administration:
  6. Adverse reactions:
  7. Drug to drug:
A
  1. Tetracyclines
  2. inhibits protein synthesis
  3. Penicillin. Acne.
  4. kids under 8 (turns teeth brown and bone probs), allergy to Tartazine, pregnancy, lactation, renal and hepatic dysfunction.
  5. don’t take with food or any milk products. Empty stomach
  6. GI, possible tooth and bone damage
  7. Oral contraceptives (cancels effectiveness), Digoxin, Penicillin G
18
Q
  1. What class of drugs was first available to treat systemic bacterial infections?
  2. What is the prototype Sulfonamide?
  3. mechanism of action:
  4. Contraindications:
  5. Adverse Effects:
  6. Drug to drug:
  7. Special considerations for pateints receiving sulfonamides:
A
  1. Sulfonamides
  2. Cotrimoxazole, Bactrim
  3. inhibit folic acid synthesis
  4. thiazide diuretics and pregnancy
  5. GI symptoms, renal effects r/t filtration of the drug (need to drink more fluids)
  6. tolbutamide, tolazamide, glyburide, glipizide, chloropropamide, cyclosporin
  7. abdomen, renal function tests, complete blood count, photosensitivity
19
Q
  1. What is Metronidazole?
  2. What is the prototype of Oxazolidinone?
  3. What is Oxazolidinone indicated for?
A
  1. an Antiprotozoal
  2. Linezolid
  3. used as a big gun in ICU
20
Q
  1. Name a few drug that treat mycobacteria:
  2. What are these drugs indicated for?
  3. What is the mechanism of action?
  4. What is essential to remember for these drugs?
  5. Adverse effects:
A
  1. Rifampin, Mycobutin, Isoniazid, streptomycin ect.
  2. active and latent TB and leprosy
  3. Act on the DNA of the bacteria leading to lack of growth and eventual death of mycobacterium
  4. Effective treatment requires more than one prototype drug.
  5. Hepatotoxicity, hyperglycemia (famous side effect), Rifampin discolors bodily fluids, Isoniazid causes Vitamin B6 deficiency.
21
Q
  1. Name some viral infections that respond to antiviral medications (4):
  2. Name some common characteristics of viruses:
  3. Name some common characteristics of antiviral drugs:
A
  1. Influenza A and B, Herpes, Cytomegalovirus, HIV, Hepatitis B and C, wart-causing/eye infection viruses.
  2. Viruses can’t replicate alone. They must attach and enter host cells. They use host cell’s energy to synthesize protein, DNA and RNA. Difficult to kill b/c live inside our own cells. Any drug that kills viruses also kills our own cells.
  3. Able to enter virus-infected cells. Interfere w/ viral nucleic acid synthesis, interfere w/ virus’s ability to bind to cells, stimulation of body’s immune system.
22
Q
      1. Name the 6 types of antiviral medications and 1 or 2 drugs from each:
A
  1. Influenza A and B agents: rimantadine, amantadine, oseltamivir (tamiflu)
  2. Herpes and CMV agents: acyclovir, famcyclovir, valacyclovir
  3. HAART (highly active antiretroviral therapy for HIV.
  4. Anti-Hepatitis B agents:
    adefovir, entecavir
  5. Anti Hepatitis C agents: simeprivir
  6. Other Locally acting antiviral agents: docosanol, imiquimod, penciclovir
23
Q
  1. Prototype of influenza antiviral agents:
  2. Mechanism of action:
  3. Adverse effects:
A
  1. Rimantadine (prophylaxis and treatment)
  2. prevention of viral uncoating
  3. diziness, insomnia, nausea, dyspnea, orthostaic hypotension, depression
24
Q
  1. Name the virus that causes painful vesicles occurring in clusters on the skin, cornea, and mucous membranes:
  2. Who gets cytomegalovirus?
  3. What are the signs and symptoms of cytomegalovirus?
  4. Nursing considerations for Herpes and cytomegalovirus:
A
  1. Herpes
  2. usually immunocompromised people like HIV patients.
  3. may be asymptomatic, fatigue, nausea, jaundice. If in pregnancy, can cause stillbirth, birth defects, and brain damage
  4. watch for allergies to antiviral meds, physical status, orientation and reflexes, skin (color, temp, and lesions), and renal function tests, CBC, Administer over 1 hour, ensure hydration
25
Q
  1. Herpes and Cytomegalovirus antiviral prototype:
  2. Adverse effects:
  3. What to teach clients about Acyclovir:
A
  1. Acyclovir
  2. headache, vertigo, tremors, nausea, vomiting, rash
  3. emphasize hydration, expect symptom relief but not cure (herpes), topical administration, no sex while lesions are present
26
Q
  1. What are the signs and symptoms of HIV/AIDS
  2. What are the drugs used to treat HIV/AIDS (6)?
  3. In general, how do HAART drugs work?
  4. What does HAART not do?
  5. What does HAART stand for and mean?
A
  1. Attacks T-cells, Causes acute infections with fever, rash, myalgia. Asymptomatic infections. Persistent, general lymphadenopathy, Constitutional Symptoms involving chronic fever and fatigue. Neuro disorders (dementia), and secondary infections like disseminated herpes simplex, and pneumocystits carnii
  2. Reverse transcriptase inhibitors, Protease inhibitors, Nucleosides - NNRTI and NRTI, Fusion inhibitors, CCR5 Coreceptor Antagonist, Integrase inhibitors
  3. inhibit viral replication enzymes, and prevents entry into host cells.
  4. Does not prevent viral mutations nor inhibit viral protein synthesis.
  5. HAART highly active antiretroviral therapy. A treatment regimen typically comprised of a combination of three or more antiretroviral drugs. The “cocktail”
27
Q
  1. What do integrase inhibitors do?
  2. Contraindications:
  3. Adverse reactions:
  4. drug to drug:
A
  1. inhibits activity of viral enzyme, integrase, a protein needed for viral replication. One of the drugs used to treat HIV
  2. nursing mothers
  3. headache, dizziness, risk of rhabdomyolysis and myopathy
  4. rifampin (causes decreased blood levels).
28
Q
  1. What are things nurses need to look out for in HIV/AIDS antiviral therapy?
  2. How do we evaluate the effectiveness of HIV meds?
  3. What is the significance of CD-4?
A
  1. history of allergy to antivirals, patient’s level of orientation, skin color, temp, lesions, temp (to monitor for infections), hepatic and renal function tests, and CBC
  2. metabolic panel, CBC, and CD4 counts
  3. CD-4 are T-helper cells. The more, the better effectiveness of the medication
29
Q
  1. What is the prototype NNRTI drug?
  2. What is the prototype NRTI:
  3. What is the protease inhibitor prototype?
  4. What is the fusion inhibitor prototype?
  5. What is the CCR5 coreceptor antagonist prototype? How does this work?
  6. What is the integrase inhibitor prototype?
  7. What do all of these drugs collectively treat?
A
  1. Nevirapine (reverse transcriptase inhibitor)
  2. Zidovudine
  3. Fosamprenavir
  4. Enfuvirtide
  5. Maraviroc - blocks viral entry to the host cell by preventing the interaction between HIV-1 ad CCR5
  6. Raltegravir
  7. HIV/AIDS. They are all HAART drugs
30
Q
  1. What is the prototype antiviral for Hepatitis B?
  2. Contraindications:
  3. Adverse effects:
  4. drug to drug:
  5. Patient education:
  6. Nursing considerations:
A
  1. Entecavir
  2. pregnancy, lactation, renal and liver disease
  3. headache, dizziness, nausea, diarrhea, elevated liver enzymes
  4. don’t take with anything nephrototoxic
  5. Important: do not stop treatment! Treatment may take months. Don’t run out of meds
  6. allergies to other antivirals, liver/kidney function tests, physical assessment, temp, level of orientation and reflexes
31
Q
  1. What type of antivirals are used to treat Hep C?

2. These may be used in combination with what to treat chronic Hep C?

A
  1. protease inhibitors

2. Ribavirin and Peginterferon

32
Q
  1. The most common infection of helminths that we will treat is ………….., a type of …………… .
  2. In the category of roundworms or nematodes, there are also …………… and …………… .
  3. Name 2 types of flatworms:
  4. What are the best ways to avoid worm infections:
  5. What is the most common antihelminth medication we will encounter?
  6. What are the nursing considerations for mebendazole?
A
  1. pinworms, roundworm
  2. ascaris and hookworms
  3. cestodes and flukes
  4. short nails, clean hands (esp after bathroom), A.M shower, change undies, pj, and linens daily
  5. Mebendazole
  6. allergies to antihelminth drugs, physical assessment, obtain stool culture for eggs, reflex and muscle strength, liver and renal tests, examine skin and abdomen
33
Q
  1. How do people become infected with protozoa?
  2. What is the most dangerous type of Malaria?
  3. What is the mechanism of action in antiprotozoal medications?
  4. What are the symptoms of Malaria?
  5. Who is most sensitive to antimalarial medications?
A
  1. Insect bites (malaria), or contact with organism (amebiasis, giardiasis, and trichomoniasis
  2. Plasmodium Falciparum
  3. inhibition of protein synthesis and DNA/RNA
  4. red blood cell destruction and toxicity to liver
  5. children, elderly, and hepatic dysfunction
34
Q
  1. Name 6 antimalarials:
  2. For what are these meds indicated?
  3. Contraindications:
  4. Adverse effects:
  5. drug to drug
  6. Important teaching point:
  7. What nurses should watch for with antimalarials:
A
  1. Chloroquine, hydroxycholorquine, mefloquine, primaquin, pyrimethamine, quinine
  2. acute malarial infection, relapse, and prophylaxis
  3. liver disease, alcoholism, pregnancy and lactation
  4. Hepatic, GI, CNS, dermatologic
  5. quinines (increased risk of toxicity)
  6. Complete prescribed dose. Continue until after travel
  7. opthalmic/retinal examinations, auditory screening, liver function, skin check for lesions, Hemolytic anemia
35
Q
  1. What is the protoype antiprotozoal (*not for malaria), and its indications?
  2. mechanism of action?
  3. Contraindications:
  4. Adverse reactions:
  5. Drug to drug:
  6. special things for nurses to watch for:
A
  1. Metronidazole. Amebiasis, giardiasis, trichamoniasis. GI infections and GU surgery
  2. DNA synthesis inhibition
  3. pregnancy, CNS or hepatic disease
  4. headache, dizziness, ataxia, nausea, vomiting, diarrhea
  5. alcohol - disulfuram. Anticoagulants
  6. CNS - check reflexes, muscle strength, skin, mucous membranes, liver function
36
Q
  1. What clients are most susceptible to fungal infections?
  2. Name the systemic antifungal drugs:
  3. what special things nurses should watch for:
A
  1. AIDS, taking immunosuppressant drugs, transplant surgery or cancer, elderly
  2. Azole antifungals, capsofungin (aspergillosis), flucytosine (candida) amphotericin B (not used much anymore b/c so toxic), nystatin (intestinal candidiasis)
  3. culture of infected area, renal and hepatic function tests (jaundice, bruising, bleeding), CBC. Monitor IV sites for phlebitis, or infiltration to surrounding tissues, infusion reactions (fever, chills, rigor, headache) Pretreat with diphenhydramine
37
Q
  1. What are Azoles indicated for?
  2. Mechanism of action:
  3. Contraindications:
  4. Adverse effects:
  5. drug to drug:
A
  1. systemic fungal infections. Less toxic than amphotericin B, but less effective
  2. binds to sterols and inhibit glucan synthesis.
  3. hepatic and renal dysfunction, pregnancy and lactation, drugs that prolong QT interval
  4. liver toxicity, tetrogenic effects
  5. many
38
Q
  1. What are echinocandins indicated for?
  2. mechanism of action:
  3. Contraindications:
  4. Adverse effects:
  5. Drug to drug:
A
  1. antifungal infections
  2. inhibit glucan synthesis.
  3. hepatic and renal dysfunction, pregnancy and lactation
  4. Liver toxicity, tetrogenic effects, bone marrow suppression
  5. cyclosporin
39
Q
  1. What is amphotericin B indicated for?
  2. contraindications
  3. adverse effects:
  4. drug to drug
A
  1. very potent - very toxic - reserved for progressive or fatal fungal infections
  2. pregnancy, lactaion, renal impairment
  3. r/t toxicity of liver and kidneys, bone marrow suppression
  4. anything that is nephrotoxic, antineoplastics, cyclosporin, or corticosteroids
40
Q
  1. the antifungal that prevents cells from reproducing by altering their cell membranes is called ………. .
  2. Contraindications of flucytosine:
  3. adverse effects:
  4. drug to drug
A
  1. flucytosine
  2. pregnancy, lactation, renal impairment
  3. toxic to liver, kidneys, and bone marrow suppression
  4. anything that is nephrotoxic, antineoplastics, cyclosporin, or corticosteroids
41
Q
  1. What do topical antifungals treat?
  2. Mechanism of action?
  3. What is a prototype:
A
  1. mycoses of skin and mucous membranes (athletes foot, vaginal yeast)
  2. alters cells permeability
  3. clotrimazole

Pharmacology 1 (4 decks)

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