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Pharmacology II > Final Exam > Flashcards

Final Exam Flashcards

1
Q

What is the mechanism of action of an ACE inhibitor?

Captopril

A

produce their effects by (1) reducing levels of angiotensin II (through inhibition of ACE), and (2) increasing levels of bradykinin (through inhibition of kinase II).

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2
Q

What are the side effects of ACE inhibitors?

Captopril

A

First dose hypotension, hyperkalemia, cough, angioedema, renal failure, fetal injury, and neutropenia (rare, but serious complication).

Generally well tolerated drugs

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3
Q

Therapeutic Uses: Verapamil

A

Angina pectoris, essential hypertension, and cardiac dysrhythmias

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4
Q

What are some drug and food interactions with Verapamil

A

digoxon, beta adrenergic blocking agents, grapefruit juice

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5
Q

What is the mechanism of action for Nifedipine?

A

Blocks calcium channels in VSM and thereby promotes vasodilation in arterioles.

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6
Q

What is some patient teaching for administration for Nifedipine?

A
  • swallow sustained release tablet whole
  • more likely to cause reflex tachycardia (can be helped with beta blocker)
  • edema can be reduced with diuretic
  • limit caffeine consumption and avoid alcohol.
  • do NOT consume grapefruit juice
  • give without regard to meals
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7
Q

What is the mechanism of action of vasodilators?

hydralazine, nitroglycerin, and prazosin

A

Hydralazine- produces selective dilation of arterioles
Nitroglycerin- produces selective dilation of veins
Prazosin- dilates arterioles and veins

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8
Q

What are the therapeutic uses for hydralazine?

A

Essential hypertension, hypertensive crisis, and heart failure

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9
Q

What are side effects of hydralazine?

A

Reflex tachycardia, increased blood volume, systemic lupus erythematosus-like syndrome
Common responses include: headache, dizziness, weakness, and fatigue

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10
Q

Furosemide and Digoxin

What do they do to each other and what do you assess?

A

furosemide can cause hypokalemia which increases the risk of digoxin toxicity
-monitor potassium and digoxin levels (0.5-0.8)

furosemide (loop diuretic) is potassium wasting

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11
Q

Mechanism of action of beta blockers

A

Block CNS catecholamines resulting in reduced renin and aldosterone release and fluid balance
Block beta1 receptors in the heart, thereby reducing heart rate, force of contraction, and AV conduction.

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12
Q

Therapeutic Outcomes for digoxin

A

Heart failure and control of dysrhythmias

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13
Q

Signs and Symptoms of Digoxin Toxicity

A

-GI: anorexia, nausea, vomiting
-CNS: fatigue and visual disturbances (yellow tinge, appearance of halos around dark objects).
-dysrhythmias

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14
Q

Drug interactions with Digoxin

A

Thiazide and loop diuretics
ACE inhibitors and ARBS
Sympathomimetics
Quinidine
Verapamil

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15
Q

What is the mechanism of action of dopamine?

A

Causes increase cardiact output; acts on Beta1 and alpha1 receptors, causing vasoconstriction in blood vessels, low dose can cause renal and mesenteric vasodilation.

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16
Q

What are the therapeutic uses of dopamine?

A

Shock and heart failure

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17
Q

Characteristics of amiodarone hydrochloride

A

Class III Antidysrhythmic
Highly effective against both atrial and ventricular dysrhythmias
(Only for life-threatening ventricular dysrhythmias)
-oral or IV
-hypotension
-can cause serious toxicities (pulmonary, cardio, thyroid, liver, pregnancy/breast feeding, ophthalmic, dermatologic)
GI and CNS reactions

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18
Q

What is the administration of adenosine?

A

Must be administered by IV bolus as close to the heart as possible

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19
Q

What are the side effects of adenosine?

A

Short lived, lasting less than a minute:
bradycardia
dyspnea
hypotension
facial flushing
and chest discomfort

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20
Q

Mechanism of Action Colesevelam?

A

-reduce LDL levels by increasing LDL receptors on hepatocytes
A nonabsorbable resin that binds (sequesters) bile acids and other substances in the GI tract and thereby prevents their absorption and promotes their excretion.

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21
Q

Mechanism of Action of Gemfibrozil

A

Decreases TG (VLDL) levels and raises HDL cholesterol levels (does not reduce LDL cholesterols to a significant deal)

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22
Q

What are adverse reactions of Lovastatin?

A

Rare: myopathy/rhabdomyolysis, hepatotoxicity, new onset diabetes.
Some develop headache, rash, memory loss, or GI disturbances (dyspepsia, cramps, flatulence, etc.)

Generally well tolerated

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23
Q

What is the class of Heparin Sodium?

A

Rapid acting Anticoagulant

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24
Q

What is the mechanism of Action of Heparin Sodium?

A

suppresses coagulation by helping antithrombin inactivate clotting factors, primarily thrombin and factor Xa

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25
Q

What is the therapeutic use of enoxaparin?

A

-prevention of postop (knee/hip replacement) DVT, PE, ischemic complications in unstable angina, non-Q-wave MI, and STEMI

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26
Q

Enoxaparin administration

A

Subq injection in the abdomen
1 mg of protamine sulfate to 1 mg of enoxaparin

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27
Q

Mechanism of Action: Warfarin

A

-inhibits vitamin K epoxide reductase complex 1 (VKORC1)
-suppresses coagulation by decreasing production of four clotting factors (VII, IX, X, prothrombin)

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28
Q

Mechanism of Action: Rivaroxaban

A

binds directly with the active center of factor Xa amd inhibits the production of thrombin

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29
Q

Mechanism of Action: Apixaban

A

inhibits factor Xa

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30
Q

Acetylsalicylic Acid (Aspirin) teaching for MI

A

-can be taken by healthy people for primary prevention of MI and stroke
-must outweight benefits against side effects (GI hemorrhage)

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31
Q

Mechanism of Action: Clopidrogel

A

blocks P2Y12ADP receptors on platelets and thereby prevents ADP-stimulated platelet aggregation

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32
Q

Mechanism of Action: Alteplase

A

binds with plasminogen to form an active complex, the complex then catalyzes the conversion of plasminogen molecules into plasmin, an enzyme that digests the fibrin meshwork of clots

33
Q

Indications for Alteplase

A

Acute MI, Acute ischemic stroke, and Acute massive PE

34
Q

Factor IX replacement therapy side effects and nursing interventions

A

-allergic reaction: administer diphenhydramine or epinephrine
-low risk of HAV, Parvovirus B19, and CJD

35
Q

Mechanism of Action: Desmopressin

A

stops or prevents bleeding in mild hemophilia A by releasing stored factor VIII from the vascular endothelium

36
Q

Side effects of ferrous sulfate

A

Gastrointestinal disturbances and staining of the teeth

37
Q

Ferrous sulfate administration

A

-take 30 min before meal or 2 hours after
-don’t take with antacids

38
Q

Patient teaching with Ferrous Sulfate

A

teeth staining can be prevented by: diluting liquid preparations with food or water, administering the iron through a straw or a dropper, and rinsing the mouth after administration

39
Q

Side effects of iron dextran

A

Anaphylaxis, hypotension, headache, fever, arthralgia, urticaria

40
Q

MOA vitamin B12

A

helps catalyze the conversion of folic acid into its active form which then participated in several reactions essential for cell growth and division

41
Q

What is required for Vitamin B12 absorption

A

intrinsic factor

42
Q

Side effects of Epoetin alfa

A

Hypertension, Cardiovascular events, rare-Autoimmune pure red cell aplasia

43
Q

Side effects of Filgrastim

A

Bone pain and Leukocytosis

44
Q

Beclomethasone (inhaled corticosteroid) side effects and teaching

A

-oropharyngeal candidiasis: gargle after admin or use spacer
-dysphonia
-bone loss: use lowest dose possible, ensure adequate calcium and vitamin D intake, participate in weight bearing exercises
-adrenal suppression
-slow growth in children

45
Q

Albuterol Teaching for administration

A

-take to abort ongoing attack or before exercise
-wait 1 minute between puffs
-may cause tachycardia, angina, and tremor
-if using ore than twice a week medications may need to be updated

46
Q

Beta 2 adrenergic agonist MOA

A

-activate beta2 receptors in the lungs, promoting bronchodilation and thus relieve bronchospasm
-small role in suppressing histamine release and increasing ciliary motility

47
Q

Salmeterol (LABA) dosing

A

-one inhalation every 12 hours
use this med before other medication
allow at least 1 min between other inhaled products

48
Q

Theophylline and smoking

A

Smoking either tobacco or marijuana accelerates metabolism and decreases half life

49
Q

Therapeutic uses: Ipratropium

A

Bronchospasms associated with COPD
Off label use for asthma

50
Q

MOA: Ipratropium

A

blocks muscarinic cholinergic receptors in the bronchi thus preventing bronchospasms

51
Q

MOA: Atropine

A

prevents muscarinic cholinergic receptor activation by endogenous acetylcholine or by drugs that act as muscarinic agonists

52
Q

Atropine therapeutic uses

A

-preanesthetic to negate profound bradycardia
-paralysis of the ciliary muscle in the eyes for exams and procedures
-bradycardia
-intestinal hypertonicity and hypermobility by lowering tone and motility
-muscarinic agonist poisoning
-PUD, decreases gastric acid secretion
-asthma
-biliary colic, relaxes biliary tract smooth muscle to help stone pass

53
Q

MOA pancuronium

A

inhibits nicotonic acetylcholine receptors by binding to receptor and blocking acetylcholine, causing muscles to relax

54
Q

Pancuronium effects on patient

A

-relax muscles
-hypotension
-does NOT diminish consciousness or perception of pain

55
Q

Drugs that intensify pancuronium effects

A

Theophylline, aminoglycosides, clindamycin, lithium, opioid analgesics

56
Q

Succinylcholine Side effects

A

Prolonged apnea, malignant hyperthermia, hyperkalemia, postop muscle pain

57
Q

MOA Levodopa

A

reduce symptoms by increasing dopamine synthesis in the striatum

58
Q

Side effects: Levodopa

A

Dyskinesias, Dark urine and sweat, N/V, postural hypotension, dysrhythmias, psychosis, CNS effects

59
Q

MOA: carbidopa

A

Inhibits decarboxylation of levodopa in the intestine and peripheral tissues which allows levodopa to be more available to the CNS

60
Q

Side effects: carbidopa

A

None on its own but can enhance levodopa side effects

61
Q

Benztropine MOA

A

alleviates symptoms by blocking muscarinic receptors in the striatum, thereby improving the balance between dopamine and acetylcholine

62
Q

Benztropine positive outcomes

A

-reduce tremor and possibly rigidity but not bradykinesia
-when used by itself in early PD it improves motor performance
-when used with levodopa in advanced PD it reduces fluctuation in motor control and may reduce levodopa dosage

63
Q

Cholinesterase Inhibitors MOA

A

prevent the breakdown of acetylcholine by acetylcholinesterase and thereby increase the availability of acetylcholine at cholinergic synapses.

64
Q

Cholinesterase Inhibitors Side Effects

A

-n/v/d
-dyspepsia
-dizziness
-headache
bronchoconstriction
symptomatic bradycardia

65
Q

MOA: Donepezil

A

Increases ACh (by inhibitng cholinesterase), which may improve memory and cognition

66
Q

Donepezil dosing frequency

A

Mild to moderate: 5mg/day - after 4-6 weeks, may increase to 10mg/day
Severe AD: 10 mg/day - after 3 months, may increase to 23 mg/day

67
Q

Therapeutic uses: interferon beta

A

-progressive relapsing MS, relapsing remitting MS, secondary progressive MS
(SP/PR/RR)

relapsing forms of MS

68
Q

Positive outcomes: interferon beta

A

-decreases frequency and severity of attacks
-reduce number and size of MRI detectable lesions
-delay progression of disability

69
Q

MOA phenytoin

A

Selective inhibition of sodium channels- as a result the drug suppresses activity of seizure-generating neurons, but leaves the healthy neurons unaffected

70
Q

Side effects of phenytoin

A

-nystagmus, sedation, ataxia, diplopia, cognitive impairment
-purple glove syndrome
-gingival hyperplasia
-morbilliform rash
-teratogen
-IV: dysrhythmias and hypotension-purple glove syndrome
-hirsutism
-disruption in vitamin D may cause rickets/osteomalacia
-rarely liver damage due to allergy

71
Q

Diazepam therapeutic uses

A

muscle spasms, spasticity
(anxiety, seizures, alcohol withdrawal)

72
Q

MOA dantrolene

A

acts directly on skeletal muscles; suppresses the release of calcium from the sarcoplasmic reticulum making the muscle less able to contract

73
Q

Dantrolene nursing assessments and interventions before admin

A

Baseline liver function tests and periodically minimize dosage

74
Q

Lidocaine purpose of administering epinephrine

A

Epi decreases local blood flow and thereby delays systemic absorption of the anesthetic; delaying absorption has two benefits: It prolongs anesthesia and reduces the risk for toxicity.

reduces intraoperative blood loss

75
Q

Nitrous oxide therapeutic benefits

A

-very low anesthetic potency; never used as primary
-very high analgesic potency; combines with other agents to enhance analgesia, and can be used alone for dentistry and labor
-20% nitrous oxide=pain relief of morphine

76
Q

Opioid tolerance

A

-use smallest amount needed to reach adequate pain relief

77
Q

Signs and symptoms of Morphine toxicity

A

-coma; cannot be aroused
-respiratory depression as low as 2-4 breaths/min
-pinpoint pupils initially but may dilate as hypoxia sets in
-treat with vent support and narcan

78
Q

MOA Naloxone

A

acts as a competitive antagonist at opioid receptors, thereby blocking opioid actions. Naloxone can reverse most effects of the opioid agonists, including respiratory depression, coma, and analgesia.

79
Q

MOA sumatriptan

A

intracranial vasoconstriction (to relieve migraine pain)

Pharmacology II (4 decks)

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