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pharmacology > final exam > Flashcards

final exam Flashcards

1
Q

Pharmacokinetics/pharmacodynamics

A

pharmacokinetics: what the body does to the drug
pharmacodynamics: what the drug does to the body

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2
Q

Drug names – generic and brand name

A

generic: cheaper, no capital letter, same chemical ingredient (may have different talc/ flavoring)
brand: name given, time-limited patent, capital letter

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3
Q

Agonist vs. Antagonist

A

agonist: mimic ligand-receptor activation response
antagonist: block the receptors activation response

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4
Q

Food and Drug Administration (FDA)’s role with medications

A

organization that protects public health, develops new drugs, black box warnings

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5
Q

Black Box Warning

A

warning issued by the FDA for drugs and medical devices that have serious or life threatening side effects

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6
Q

Drug Enforcement Agency (DEA)

A

enforces controlled substance laws and regulations, drug diversion

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7
Q

Scheduled Medications/Controlled Substances

A

categorized by schedule (I-V) therapeutic, potential abuse, nursing duties for storage, administration, and record keeping

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8
Q

the different schedules

A

schedule 1 has no current medical use for the medication, ex: heroin.
schedule 2 has a high potential for abuse and are considered dangerous, ex: Vicodin.
schedule 3 has a moderate to low potential for abuse, ex Tylenol with codeine.
schedule 4 is low potential for abuse and low risk for dependence, ex: Xanax. schedule 5 has minimal potential for abuse, ex: Lomotil

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9
Q

Medication administration – 5 rights

A

right dose, right patient, right route, right time, and right medication

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10
Q

High Risk Medications (APINCH)

A

A: anti-infective, P: potassium/ other electrolytes, I: insulin, N: narcotics, C: chemotherapeutic agents, H: heparin/ anticoagulants

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11
Q

Medication errors and how to prevent

A

errors: information management in health records, unrecognized patient deterioration, implementation of clinical support, fatigue, interruption, multitasking, emotional stress and how to prevent: patient transfer, patient identification, system factors, know medicines, patient education, double check

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12
Q

Antibiotic resistance

A

occurs when bacteria change and are no longer affected by antibiotics, which are designed to kill them. This can happen through a variety of mechanisms

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13
Q

Penicillin’s

A

Effective againest: i. Gram (+) and Gram (-) bacteria
treats: Pneumonia,Meningitis, Otitis Media,Strep Throat, Syphilis
Common penicillin medications-
i. Amoxicillin
ii. Penicillin V
d. Contraindications
i. Allergies to penicillin or cephalosporins
e. Adverse Effects-
i. Most significant = GI distress
ii. Superinfections: yeast infection or C.Diff
iii. Severe: hypersensitivity or anaphylaxis
f. Drug–Drug Interactions-
i. Tetracyclines
ii. Warfarin
g. Nursing Considerations
Evenly space dosages Monitor for signs of superinfections
Advise with birth control
Consider probiotics
Culture and sensitivity tests

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14
Q

Cephalosporins

A

MOA: Inhibit bacterial
cell wall synthesis
indication: More serious infections:
pneumonia, meningitis, kidney
SE: GI distress, bleeding, Superinfections (black/ furry tongue, yeast infection, C.Diff
NI/CE: Monitor for signs of superinfection, Interact with alcohol
CI: Renal impairment, alcohol

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15
Q

Sulfonamides

A

Medication - Trimethoprim/Sulfamethoxazole (Bactrim)
MOA - inhibits metabolic activity by preventing dihydrofolic acid formation
Indications - treat UTI, ear infection, traveler’s diarrhea, skin infection
SE - photosensitivity, crystalluria, hypersensitivity
NC - Known allergy to any sulfonamide or thiazide diuretics, encourage hydration, discuss risk for photosensitivity with sun exposure
CI - Monitor for thrombocytopenia, do not use with infants under 2 months, kidney and liver impairment
Broad-spectrum against gram positive and gram negative organisms

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16
Q

Fluoroquinolone’s

A

(Levofloxacin, Ciprofloxacin)
MOA: Inhibits bacterial DNA replication
Indications: Pneumonia, complicated urinary or skin infections
Very broad spectrum of activity. Active against most aerobic gram negative bacteria and some gram positive.
AE: Gi upset, photosensitivity, dizziness, tendon rupture, peripheral neuropathy, CNS effects, C. diff.

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17
Q

Macrolides

A

End in mycin
Drug: Azithromycin
Gram-positive and gram-negative organisms
MOA: Inhibit RNA synthesis
Indications: Respiratory infections, ear infections and Chlamydia
SE: GI upset, drowsiness, QT prolongation
Nursing Considerations: advise to take with food in GI upset

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18
Q

Amino glycosides

A

A group of powerful antibiotics used to treat serious infections.
(Used for gram negative bacterias)
Medications: Streptomycin or Gentamicin (IV or IM); Gentamicin (ophthalmic)
Indications: Streptomycin or gentamicin to treat endocarditis or abdominal infections; Gentamicin ophthalmic to treat eye infections
Pharmacokinetics: Rapidly absorbed IV or IM injection, reaching peak levels within 1-2 hours, excreted unchanged in the urine and have an average half-life of 2-3 hours, depend on the kidneys for excretion
Adverse effects: GI upset, rash, nephrotoxicity, ototoxicity
Contraindications: Renal or hepatic disease, hearing loss
Nursing considerations: Monitor peak and trough (narrow therapeutic index), peak level should be obtained 1-2 hours after administration, obtain trough level just before next dose.

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19
Q

Tetracycline

A

Medications include tetracycline and doxycycline
Indications include acne, lyme disease
Adverse effects include GI upset, C. Diff, Photosensitivity, superinfections, teeth staining in children
Contraindications include known allergy to tetracyclines, children under 8 (cause teeth staining), and pregnancy
Nursing considerations include avoid sun (photosensitivity), Avoid within 1-2 of dairy, antacids, and iron, and Decrease effectiveness of oral contraceptives

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20
Q

Vancomycin

A

Indication = treat serious gram-positive infections like MRSA
Administered IV or orally for C-Diff
AE = Nephrotoxic, Ototoxic, “red man syndrome”
NC = administer over 60 min or more (avoid rapid infusion)

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21
Q

Antiviral drugs (herpes and influenza)

A

Herpes drug- Acyclovir
Influenza drug- Tamiflu

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22
Q

Antifungals

A

Pts susceptible- AIDS, immunosuppressants, transplant surgery or cancer treatment
Clotrimazole (imidazole), PO or topical
MOA- binds to sterols (lipid in fungal cells) by disrupting ergosterol biosynthesis of CM, increasing cellular permeability and causes cell death
Indications- tinea skin infections, candidiasis infections
SE- irritation, burning, rash, swelling; liver toxicity, inhibits testosterone synthesis
CI- hepatic and renal dysfunction
Ketoconazole (imidazole), topical
MOA- alter cell replication of the fungus
Indication- tinea skin infections, cutaneous candidiasis, seborrheic dermatitis, dandruff
SE- irritation, burning, rash, swelling; liver toxicity, inhibits testosterone synthesis
Amphotoericin B
MOA- disrupt fungal CM, altering cell replication of fungus and causing cell death
Indication- very potent; serious fungal infections like systemic mycosis, fungal meningitis; last resort for protozoan infections
SE- hepatotoxicity, nephrotoxicity, ototoxicity; hypokalemia, GI upset; hearing loss and bone marrow suppression; fever, chills, arrhythmias, anemia, IV phlebitis

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23
Q

Autonomic Nervous System (SNS and PNS)

A

Maintains and regulates body function. Unconscious control. SNS = fight or flight and norepinephrine. PNS = rest and digest and acetylcholine. SNS has alpha and beta receptors. “ABCD” Alpha causes Constriction. Beta causes Dilation.

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24
Q

Pseudoephedrine

A

MOA: Shrink the nasal mucous membrane by stimulating the
alpha-adrenergic receptors in the nasal mucous membrane indication: Decrease nasal congestion related to the common cold, sinusitis, and allergic rhinitis
SE: Rebound congestion, Hypertension, Sympathetic effects

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25
Q

Tamsulosin

A

block alpha 1- receptor in the prostate, this causes relaxation of bladder
and prostate and improves urine flow. indication: Benign Prostatic Hyperplasia
SE: orthostatic hypotension and syncope (30-90 minutes after first
dose)
NI/CE: 30 mins after meal, swallow whole, monitor BP
CI: kidney and liver problems, low BP

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26
Q

Clonidine

A

Therapeutic class: antihypertensives Clonidine available forms: Epidural, tablets and transdermal injection. MOA- unknown Thought to stimulate alpha2 receptors and inhibit central vasomotor centers, decreasing sympathetic outflow to the heart, kidneys, and peripheral vasculature and lowering peripheral vascular resistance,BP and HR. Adverse reactions- Bradycardia, chest pain, hypotension, tachycardia, drowsiness, dizziness, confusion, lethargy, constipation, nausea and vomiting.Nursing considerations:drug may be given to rapidly lower BP in some hypertensive emergencies, frequently monitor BPand pulse rate, Observe patient for tolerance to drugs therapeutic effects which may require increased dosage.

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27
Q

Metoprolol vs. Propranolol

A

Metoprolol and propranolol are both beta-blockers, but they differ in selectivity and uses. Metoprolol is a selective beta-1 blocker, primarily affecting the heart and causing fewer respiratory side effects, making it suitable for patients with asthma or COPD.Its commonly used for hypertension, post-heart attack care, and heart failure. Propranolol, a non selective beta blocker, affects both beta-1 and beta-2 receptors, which can impact the heart, lungs, and other organs, leading to potential bronchoconstriction, making it less suitable for people with respiratory issues. ​ropranolol is used for a broader range of conditions, including hypertension, migraines, and anxiety. Metoprolol has a more cardio-specific effect, while propranolol may have more pronounced central nervous system effects due to its lipid solubility.

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28
Q

Epinephrine

A

A hormone and medication, also known as adrenaline.
Drug Class: Epinephrine is an alpha and beta adrenergic agonist.
MOA: This is produced in the adrenal medulla and is stimulated by the sympathetic nervous system. Epinephrine helps open airways and causes vasoconstriction (which reduces swelling).
Indication: It can be used to treat anaphylaxis, asthma attacks, cardiac arrest, and low blood pressure.

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29
Q

Dobutamine

A

Beta-1 Agonist
MOA: Stimulates beta-1 receptors to increase heart rate, force, contractions, and velocity
Indications: cardiogenic shock and severe heart filature to increase contractility and cardiac output
Contraindications: Corn allergy if dextrose is used, history of hypertension, acute MI, sulfite sensitivity
SE/AE: Increased heart rate and blood pressure, labored breathing, angina, palpitations, and dizziness
NC: Monitor EKG blood pressure, and cardiac output

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30
Q

Donepezil (treatment for Alzheimer disease)

A

Indirect-acting muscarinic cholinergic agonist
Enhances memory in some patients with early Alzheimer’s disease

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31
Q

Anticholinergic Drugs

A

Drug: Tiotropium
Class: anticholinergics long acting
MOA: blocks acetylcholine in bronchial smooth muscles, which reduce broncho-constrictive substance release
Indication: maintenance treatment of bronchospasm associated with COPD or asthma
Side Effect: cough, drying of nasal mucosa, anticholinergic effects (dry mouth), nervousness, headache, dizziness
NI/CE: caution with any condition that would be aggravated by the anticholinergic effects of the drug (ex. parkinsons)
Drug: Ipratropium
Class: anticholinergics short acting
MOA: anticholinergic that blocks vagally mediated reflexes by antagonizing the action of acetylcholine
Indication: maintenance treatment of bronchospasm associated with chronic obstructive pulmonary disease; treatment of seasonal allergic rhinitis as a nasal spray
Side Effect: nervousness, dizziness, headache, GI distress, cough, palpitations
Drug: Scopolamine
Class: Anticholinergic
MOA: blocks ACh receptors in vestibular system
Indication: nausea and vomiting associated with motion sickness/surgery
Side Effect: anticholinergic effects, decreased GI motility, urinary retention
NC/CE: Do not cut patch, Apply to hairless skin behind ear for 3 days or apply the night before surgery and remove 24 hours later, remove before MRI
Contraindications (CI): glaucoma
Drug: dicyclomine
Class: Anticholinergic
Indication: Irritable Bowel Syndrome
Side Effect: drowsiness, constipation, dry mouth
NC/CE: oral

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32
Q

Anticholinergic effects and SLUDGE effects

A

SLUDGE effects: Sweating, salivation, lacrimation, urination, diaphoresis, gastrointestinal cramps/pain, and emesis.

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33
Q

Make up of Nervous System (CNS and PNS) and function of nervous system

A

The CNS includes the brain and spinal cord, while the peripheral nervous system consists of everything else. The CNS’s responsibilities include receiving, processing, and responding to sensory information

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34
Q

Disorders of the CNS and basic understanding of each

A

Vascular disorders, such as stroke, transient ischemic attack (TIA), subarachnoid hemorrhage, subdural hemorrhage and hematoma, and extradural hemorrhage.

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35
Q

Benzodiazepines

A

MOA: Act in the limbic system and the RAS, make GABA more effective, lower doses assist with anxiety, higher doses cause sedation and hypnosis
Indication: Anxiety disorders, alcohol withdrawal, hyperexcitability and agitation, status epilepticus, preoperative relief of anxiety and tension to aid in balanced anesthesia
sedation and hypnosis
Drug: lorazepam
AE: respiratory depression, sedation, drowsiness, lethargy, hypotension
Contraindications: Allergy to benzodiazepine, Psychosis, Acute narrow angle glaucoma
Shock, Coma, Acute alcohol intoxication, Pregnancy
Education: caution when driving, risks for falls, avoid alcohol, caution with elderly, risk for dependence and overdose
(metabolized in the liver, excreted in the urine)

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36
Q

CNS Stimulant (ADD/ADHD)

A

Methylphenidate (Chapter 8, Week 6 ppt)
- MOA: stimulates the brain and blocks reuptake of norepinephrine and dopamine
- IN: ADHD, ADD
- Side effects: cardiovascular events, HTN, headache, insomnia, abuse and dependence
- Considerations: potential for abuse, CV and psychiatric risk, HTN

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37
Q

SSRI’s

A

Serotonin Reuptake Inhibitors #1
Blocks the reuptake of Serotonin
Fewer side effects than TCAs and MAOIs

Selective Serotonin Reuptake Inhibitors #2
Actions - Inhibits CNS neuronal reuptake of serotonin
Indications-Depression, OCDs, panic attacks, bulimia, posttraumatic stress disorders, and other forms of anxiety

Selective Serotonin Reuptake Inhibitors #3
Pharmacokinetics
-Absorbed from the GI Tract
-Metabolized in the liver
-Associated with congenital deformities

Contraindications
-Known allergy, pregnancy, lactation, impaired renal function, MAOI, Grapefruit juice

Selective Serotonin Reuptake Inhibitors #4
Adverse Effects
-Headache, drowsiness, decreased libido, urinary retention, insomnia, hypotension, suicidal thoughts or serotonin syndrome

Drug-Drug Interactions
-MAOIs
-TCA increase of therapeutic and toxic effect

38
Q

Serotonin syndrome

A

Increased serotonin in the CNS and is life-threatening
Symptoms:
mental status changes (agitation, coma, hallucinations)
Autonomic instability (tachycardia, changing BP, hypertension)
Hyperreflexia
Nausea and Vomiting

39
Q

MAOI

A

Monoamine Oxidase Inhibitors; indicated for treatment of patients with depression who are unresponsive to, or unable to take other antidepressant medications. Acts to irreversibly inhibit MAO, allowing norepinephrine, serotonin, and dopamine to accumulate in synaptic cleft. Pharmacokinetics include GI Tract absorption, peak effects in 3-4 hours, metabolized in liver, excreted in urine, and crosses placenta and enters breast milk. Contraindicated in patients with an allergy, cardiovascular disease, headaches, and renal/hepatic impairment. Adverse effects include hypotensive crisis, orthostatic hypotension, liver toxicity, CNS symptoms, mania, anorexia, serotonin syndrome, suicidal thoughts

40
Q

Lithium

A

Mood stabilizer
Indication: bipolar disorder
MOA: Alters sodium transport in nerve and muscle cells, inhibits the release of norepinephrine and dopamine, but not serotonin, from stimulated neurons
AE: related to lithium serum level (therapeutic range is 0.8-1.2 mEq/L)
1.2 - 1.5 – lethargy, slurred speech, muscle weakness, thirst, polyuria
1.5 - 2.0 – above reactions plus ECG changes
2.0 - 2.5 – ataxia, clonic movements, hyperreflexia, seizures
>2.5 – multiorgan toxicity, significant risk of death
Nursing considerations: Slowly crosses the blood brain barrier, crosses the placenta, enters breast milk, monitor sodium level: low sodium = risk for toxicity
Contraindications: Known allergy, renal, cardiac disease, leukemia, metabolic disorders, pregnancy, lactation

41
Q

First and second-generation antipsychotics and extrapyramidal side effects

A

first generation (haloperidol): reduces positive symptoms, can cause extrapyramidal symptoms, multiple drug interactions, MOA: block dopamine receptors
Second generation (risperidone): reduces positive and negative symptoms, increases metabolic syndrome and weight gain, multiple drug interactions, MOA: blocks specific dopamine 2 receptors and serotonin receptors
Extrapyramidal symptoms: Akashia, pseudo-Parkinson’s, acute dystonia

42
Q

Anticonvulsants (seizure drugs) and nursing considerations

A

DRUGS: phenytoin, levetiracetam, gabapentin
Levetiracetam (Keppra)
MOA: slows down electrical impulses of brain by interfering with electrolytes and GABA transmission
Serious side effects: Serious skin reaction; abnormal blood count
Gabapentin
MOA: inhibits the release of excitatory neurotransmitters in a similar pathway to GABA
Indication: seizures and neuropathic pain
SE: Drowsiness, dizziness, mood changes (suicidal); drug reaction with eosinophilia and systemic symptoms (DRESS)
Nursing considerations: avoid antacids for 2 hours; don’t stop abruptly

43
Q

Parkinson’s and Carbidopa/levodopa

A

Parkinson’s Disease: a progressive disease of the Central Nervous System impairing body movements. The cause is not known but is a loss of dopaminergic neurons. Onsets later in life with no cure.
Symptoms: tremor, bradykinesia, muscle rigidity, instability, dystonia, gat disturbance
Carbidopa/levodopa
Class: Anti-Parkinson Agent
MOA: Levodopa circulates to the Blood Brain Barrier to convert to dopamine. Carbidopa inhibits peripheral plasma breakdown of levodopa and increases it at the BBB.
Side Effects: Nausea, mood changes, dyskinesia (uncontrolled or involuntary movements), peripheral neuropathy
Admin: Oral, intestinal suspension, intestinal gel
Contraindications: older adults may be more sensitive to CNS effects
Nursing Considerations: monitor mental state, plan giving around mealtimes, avoid high protein diets

44
Q

Opioid Analgesics

A

MOA: binds to opioid receptors in CNS to alter perception of painful stimuli
o Indications: moderate-severe acute/chronic pain
o AE: respiratory depression, hypotension, light-headedness, dizziness, sedation, constipation, nausea, vomiting, sweating
· Fentanyl: synthetic
· Morphine: natural
· Oxycodone (semi-synthetic)
· Tylenol with codeine

45
Q

Naloxone

A

Reverses adverse effects of narcotics; diagnoses suspected acute narcotic overdose.
o Actions: reverses opioid agonist, and analgesic and CNS depression caused by opioid agonist.
o Indications:
§ Reversal of the adverse effects of narcotics.
§ Treat narcotic dependence.
o Pharmacokinetics:
§ Well absorbed after injection and are widely distributed in the body.
§ Hepatic metabolism and excreted in the urine.
§ Enter breast milk.
o Contraindications: known allergy.
o Adverse effects: agitation, tremors, drowsy, sweating, hypertension, decreased respirations.
o Naloxone with opioid dependence:
§ Acute withdrawal syndrome S/S: body aches, fever, congestion, weakness, shivering or trembling, irritability, increased blood pressure and tachycardia.
§ Newborns: may experience convulsions, decreased reflexes and crying.

46
Q

Acetaminophen

A

Mechanism of Action
Acetaminophen inhibits the synthesis of prostaglandins that may serve as mediators of pain and fever primarily in the CNS
Indications for Use
Acetaminophen is used to treat mild pain and fever; however, it does not have anti-inflammatory pro
Acetaminophen is safe for all ages and can be administered using various routes.

Adverse effects include skin reddening, blisters, rash, and hepatotoxicity.

Therapeutic Effects- Relief of mild pain and fever

Class- analgesic, Antipyretic

47
Q

NSAIDS

A

nonsteroidal anti inflammatory drugs
Include aspirin, ketorolac, celecoxib
Common AE: GI bleeds and discomfort, increased blood volume issues and clotting, adverse kidney effect (ie. electrolyte imbalances)
Indications: analgesic, antipyretic, anti inflammatory
MOA: inhibit prostaglandins, decrease platelets

48
Q

Types of anesthetics (Inhaled, IV and Muscle Relaxants)

A

-Inhaled: Nitrous Oxide
MOA: Enters bronchi and alveoli depressing CNS via capillary system
-ALWAYS given with OXYGEN
-Flammable and potent
-Onset within 1-2 minutes
-SE: Anxiety, delirium, CV and respiratory depression, hiccups, apnea, middle ear pain
-IV: Anesthetics
-Fentanyl- opioid receptors in CNS, causing CNS depression altering perception of pain
-Propofol- Ideal for most procedures, rapid onset, rapidly absorbed through blood brain barrier, can cause hypotension, respiratory depression, and bradycardia
-Methohexital- 10-20 second onset, can cause CNS depression, CV depression, and respiratory depression
-Muscle Relaxants: muscle relaxation for surgical procedures
-Succinylcholine
-30 to 60 second onset
-SE: muscle pain, flaccid paralysis, respiratory depression, apnea, malignant hyperthermia

49
Q

Upper respiratory disorders

A

Allergic rhinitis (An allergic reaction caused by exposure to allergens)
Common cold (A viral infection of the upper respiratory tract)
Sinusitis (Inflammation or infection of the sinus cavities)
Pharyngitis (Inflammation of the pharynx)
Laryngitis (Inflammation of the larynx)

50
Q

Antihistamines

A

-indications: treat allergic reactions
-MOA: block histamine receptors
-nursing considerations: assess allergies, monitor for sedation or anticholinergic effects, ensure patient is hydrated, educate patient not to drink alcohol while taking
-contraindications: hypersensitivity, use caution if pregnant, avoid with narrow angle glaucoma, do not use if patient has liver or kidney damage
-adverse effects: sedation, dry mouth/throat, dizziness, lightheaded, blurred vision, constipation, headache, nausea, vomiting, cardiac arrythmias

51
Q

Decongestants

A

Drug : Pseudoephedrine
Decreass Nasal congestion related to the common cold, sinusitis, and allergic rhinitis
MOA: Shrinks the nasal mucous membrane by stimulating the alpha andrenergic receptors in the nasal mucous membranes
Indication: Promotion of drainage in the sinuses and improving airflow
SE: Rebound congestions, Hypertension, Sympathetic effects
Topical Nasal Steriod Decongestants
Drug: Fluticasone Nasal Spray
MOA: Relieves inflammation
Indications: seasonal allergic rhinitis
SE: Local burning, irritation, stinging, dryness of the mucosa, and headache

52
Q

Asthma – triggers, treatment, patient teaching regarding inhaler use

A

triggers, treatment, patient teaching regarding inhaler use
Treatment of Asthma: Practice allergen avoidance, Use agents that suppress immune response, and carry fast-acting agents to reverse symptoms.

53
Q

COPD

A

Chronic Obstructive Pulmonary Disease
Forms- Emphysema and chronic bronchitis
Patients with COPD- Chronic illness, vulnerability, and dyspnea. Often oxygen dependent. Chronic hypoxemia and hypercapnia
Symptoms- Shortness of breath, Wheezing, Chest tightness, Cough, Cyanosis, and Frequent respiratory infections
Treatment- Smoking cessation, Pursed lip breathing, Administration of oxygen, Incentive spirometry, Use of preventative and rescue inhalers

54
Q

Short-acting and long-acting beta agonist inhalers

A

Albuterol
Class: short acting beta 2 agonist
MOA: Reacts as an agonist at beta-receptor sites in the SNS to cause bronchodilation, increased HR, RR, and BP
Indications: Treatment and prophylaxis of bronchospasm and prevention of exercise-induced bronchospasm
Contraindications: hypersensitivity to drug/milk proteins, death reported with excessive use in patients with asthma, cautiously used for patients with CV disorder/seizures/hyperthyroidism/diabetes
SE: fear, anxiety, restlessness, headache, sore throat, dizziness, nausea, palpitation, tachycardia, paradoxical bronchospasm, hypersensitivity
NC: May decrease sensitivity of spirometry for diagnosis of asthma, syrup contains no alcohol/sugar and is safe for children as young as 2 years old, monitor for hypersensitivity, corticosteroids may be needed to treat asthma with albuterol, for COVID-19 and COPD symptoms usage include a pressurized metered-dose inhaler
Salmeterol
Class: long acting beta 2 agonists
MOA: mimics effects of SNS to cause bronchial dilation with increased rate and depth of respiration
Indications: acute asthma attack, bronchospasm, prevention of exercise-induced bronchospasm
Contraindications: hypersensitivity, seizures, hyperthyroidism, hypokalemia, hepatic impairment
SE/AE: sympathomimetic stimulation (tachycardia), CNS stimulation (tremors)
NC: is not a monotherapy for bronchospasm (BB warning), do not take with other LABA medications

55
Q

Fluticasone inhaler (Inhaled corticosteroids)

A

Class: corticosteroid
IND: preventative treatment for asthma and COPD
MOA: Corticosteroid that reduces inflammation in airways. Taken regularly with an inhaler/ puffer
SE: Throat irritation, hoarseness, cough, oropharyngeal candidiasis, flu like symptoms, increases infection risks,
NC: Safe in 4 years and older, increase in blood glucose, weight gain, swelling, increase fatigue, bruising, and behavior changes

56
Q

Prednisone

A

Drug class: Corticosteroids
Indication: severe inflammation, disorders requiring immunosuppression, endocrine deficiency disorders or Acute exacerbations of MS
MOA: Decreases inflammation, mainly by stabilizing leukocyte lysosomal membranes; suppresses immune response; stimulates bone marrow; and influences protein, fat, and carbohydrate metabolism.
Side effects: Fluid retention, edema, hypertension, Na, K+, Ca effects, mood swings, nausea, vomiting, bone reabsorption, delayed wound healing, increased risk for infections
Contraindication:systemic fungal infections, cerebral malaria, or active ocular herpes simplex;, Use cautiously in patients with recent MI, GI ulcer, kidney disease, HTN, osteoporosis, diabetes, seizures, hypothyroidism, cirrhosis, active hepatitis, diverticulitis, nonspecific ulcerative colitis, recent intestinal anastomosis, thromboembolic disorders, myasthenia gravis, HF, TB, ocular herpes simplex, and psychiatric disturbances.
Patient Education: Do not stop drug abruptly, Report all adverse reactions, tell patients with long term use to consider PT or exercise, and report pregnancy or breastfeeding.

57
Q

Montelukast

A

Indications: Asthma, seasonal allergic rhinitis
Route: By mouth
MOA: Reduces early and late phase bronchoconstriction and nasal mucosa inflammation from antigen challenge
SE/AE: headache, dizziness, fatigue, wheezing, pneumonia
Contraindications: hypersensitivity, avoid using aspirins
Considerations: Assess patient’s underlying condition, monitor for effectiveness. Monitor patients for neuropsychiatric symptoms.

58
Q

Risks of untreated hypertension

A

Heart failure/Heart disease
Stroke
Angina (chest pain)
Aneurysm
Damage to the kidneys
Memory and vision problems

59
Q

Hypertension patient teaching points

A

Eating a heart healthy diet with less salt.
Getting regular physical activity.
Maintaining a healthy weight or losing weight.
Limiting alcohol.
No smoking.
Getting 7-9 hours of sleep daily.

60
Q

Nitroglycerin

A

Indication: angina and chest pain
MOA: relax vascular smooth muscle, vasodilation
Adverse effects: hypotension, palpitations, headache, flushing, nausea, vomiting, dizziness
Instructions: sublingual, sit while taking
Nurse: check BP, call 911, patient may take up to 3 to relieve chest pain
CI: sildenafil (viagra)

61
Q

Antiarrhythmic drugs (Identify class)

A

Class I: Sodium Channel Blockers
Class II: Beta Blockers
Class III: Potassium Channel Blockers
Class IV: Calcium Channel Blockers

62
Q

Digoxin

A

a. Indication: cardiac failure and arrhythmias (specifically A-fib)
b. MOA: inhibits Na and K in the myocardium which increases intracellular concentration of calcium
c. Adverse effects: nausea, diarrhea, headaches, anxiety, depression, rash, angina, vision changes, facial edema
d. Nursing considerations: don’t give if pt has hx of kidney failure or low potassium; don’t give with antibiotics

63
Q

Loop diuretic

A

Increase the excretion of sodium and water from kidney to lower BP
Drug: Furosemide
MOA: loop diuretic that inhibits absorption of sodium and chloride, causing fluid loss, along with sodium and potassium loss
Indication: edema and hypertension
Adverse effect: dehydration, hypotension, electrolyte imbalance (hypokalemia)
Nursing considerations: give slowly (risk of ototoxicity), monitor BP and potassium, assess for dehydration

64
Q

Thiazide diuretic

A

Diuretics are drugs that increase the excretion of water and sodium from the kidney leading to lowered blood pressure. Hydrochlorothiazide:
MOA: works near distal tubule, promotes excretion of sodium and water
Indications: edema and hypertension
SE: dehydration, hypotension
Nursing considerations: taken daily and does not have immediate effects

65
Q

Potassium sparing diuretic

A

Spironolactone [Aldactone] is the potassium sparing diuretic:
MOA: binds to aldosterone reception in distal convoluted renal tubule; causes increased amounts of sodium and water excreted while potassium is retained
Indications: hypertension, acne
Contraindications: hyperkalemia, electrolyte imbalance, tumorigenic
Side Effects/Adverse Effects: hyperkalemia, dehydration, hypotension
Nursing consideration: monitor potassium, educate to take daily, avoid potassium rich diet

66
Q

ACE inhibitor

A

Drug: Captopril
MOA: block ACE from converting angiotensin I to angiotensin II causing decreased BP, aldosterone production, small increase in serum potassium levels along with sodium and fluid loss
Indication: treatment of hypertension, CHF, diabetic nephropathy, L ventricular dysfunction following MI
CI: pregnancy and lithium
Education: avoid salt substitutes and food high in potassium
SE: dry hacking cough, hypotension, renal insufficiency, tachycardia, MI, rash, pruritus, GI irritation, aphthous ulcers, proteinuria, bone marrow suppression, cough
Severe: angioedema - part of body becomes swollen areas include lips, tongue, eyelids, hands, feet

67
Q

ARBS

A

MOA: selectively bind with the angiotensin II receptors in vascular smooth muscle and in the adrenal cortex to block vasoconstriction and the release of aldosterone Indications: hypertension, diabetic neuropathy Contraindications: hypersensitivity SE/AE: hypotension, headache, dizziness, syncope, weakness, diarrhea, abdominal pain, cough, back pain NC: watch for signs of impaired renal function, assess dizziness

68
Q

Atorvastatin

A

Indication: Adjunct to diet in the treatment of elevated cholesterol,
§ lower LDL and triglycerides
§ increase HDL
MOA: Inhibits HMG-CoA, decreases serum cholesterol levels, LDLs, and triglycerides, increases HDL levels
AE: Muscle symptoms (myalgias to rhabdomyolysis) Liver injury GI symptoms: Flatulence, abdominal pain, cramps, nausea, vomiting, and constipation CNS: Headache, dizziness, blurred vision, insomnia, fatigue
Contraindication: Active liver disease or history of alcoholic liver disease
Drug to Drug interactions: Erythromycin, cyclosporine, gemfibrozil, niacin Digoxin or warfarin Estrogen Grapefruit juice

69
Q

Warfarin and antidote

A

Indication: Prevent thromboembolism (Deep vein thrombosis and pulmonary embolism), Atrial fibrillation
MOA: It inhibits Vitamin K enzyme that causes clotting factors. This leads to a decrease in clotting factors and a reduce blood coagulation
Adverse effects: Bleeding complication
Contraindications: Bleeding disorders, uncontrolled hypertension, pregnancy.
Education: Watch vitamin K (green leafy vegetables), signs of bleeding
Drug interaction: NSAIDS, antibiotics
Antidote: Vitamin K reverse the effect of warfarin

70
Q

Aspirin

A

MOA: inhibits platelet activation and aggregation
Indications: MI, stroke, anti-inflammatory, analgesic, antipyretic effects
Caution: bleeding disorder, recent surgery, closed head injury
AE: bleeding, HA, dizziness, weakness, GI distress
Nursing Considerations: avoid NSAIDs, don’t give to children 12 and younger as it could cause Reye’s syndrome, monitor for bleeding

71
Q

Sildenafil

A

akes 30-60 minutes to work prior to sexual activity
MOA: causes muscle relaxation and vasodilation
Indications: erectile dysfunction
AE: Orthostatic hypotension, urinary frequency, bladder pain

72
Q

Diabetes type 1 and type 2 and goal of treatment

A

type 1- the body can’t make insulin on its own. type 2: the bodys ineffective use of insulin, leads to high blood sugar levels, body doesn’t produce enough insulin or is resistant to it. Goal of treatment is to regulate blood glucose levels.

73
Q

Types of Insulin

A

Rapid acting, Short acting, Intermediate acting, Long acting.

74
Q

Hypoglycemia and hyperglycemia

A

Hypoglycemia Mild-to-Moderate:
⁃ Shaky or jittery
⁃ Sweaty
⁃ Hungry
⁃ Headache
⁃ Blurred vision
⁃ Sleepy or tired
⁃ Dizzy or lightheaded
⁃ Confused or disoriented
⁃ Pale
⁃ Uncoordinated (appears drunk)
⁃ Irritable or nervous
⁃ Argumentative or combative
⁃ Changed behavior or personality
⁃ Trouble concentrating
⁃ Weak
⁃ Fast or irregular heartbeat
Severe:
⁃ Unable to eat or drink
⁃ Seizures or convulsions (jerky movements)
⁃ Unconsciousness
Hyperglycemia:
⁃ Fruity odor to breath
- Polyuria progressing to oliguria, polydipsia, polyphagia
⁃ Kussmaul’s respirations (rapid and deep)
⁃ Sluggish, Drowsy, stupor
⁃ Hypotension, tachycardia
⁃ Skin warm and dry, dry mucous membranes
- Severe cases: Diabetic Ketoacidosis

75
Q

Glipizide (Sulfonylurea)

A

Glipizide is a sulfonylurea. MOA: beta cell of the pancreases secretes insulin has a sulfonylurea receptor. When stimulated the receptor causes the beta cell to release insulin. 1) stimulate beta cells to increase insulin secretion. 2) increase peripheral insulin sensitivity. 3) reduced hepatic glucose production. This lowers the blood glucose and SE: hypoglycemia.

76
Q

Metformin (Biguanide)

A

MOA: Decrease liver glucose production and intestinal absorption of glucose, also increases insulin sensitivity
Indications: Prevention of type 2 diabetes in pre diabetic patients, lower glucose in those with type 2 diabetes
SE: Diarrhea, nausea,vomiting , constipation
CI: Those with liver disease or those at risk for lactic acidosis, eGFR below 30ml/min
Client education and nursing consideration: Educate on when to take, side effect signs, monitor blood glucose, monitor liver and kidney function

77
Q

Semaglutide

A

Therapeutic class: antidiabetic
MOA: Stimulates release of insulin and lowers glucagon secretion in presence of elevated glucose levels.
Administration: PO
Indications: for patients with diabetes trying to control their weight
Contraindications: Contraindicated in patients hypersensitive to drug or its components, drug not indicated for patients with type 1 diabetes
Adverse effects: CNS: headache, fatigue, dizziness. CV: increased HR, hypotension. EENT: diabetic retinopathy complications. GI: nausea, vomiting, diarrhea, abdominal pain, constipation, dyspepsia, belching, flatulence, GERD
Nursing considerations: Monitor patients for hypersensitivity reactions, including anaphylaxis and angioedema. Discontinue drug and treat appropriately if reaction occurs. Use cautiously in patients with a history of hypersensitivity to another glucagon-like peptide-1 agonist

78
Q

Addison’s and Cushing’s

A

Addison’s – low/absent steroid
Cause: Dysfunction of the hypothalamus–pituitary gland–adrenal gland feedback loop
Results in insufficient production of steroids by the adrenal glands
Most cases are considered an autoimmune disorder
Treated with: Add-sone Diet Don’t abruptly stop Don’t believe the medication will cure Indefinitely “life long”
Cushing’s – high steroid
Treat with: Glucocorticoids

79
Q

Glucocorticoid and side effects

A

Drugs: Prednisone (PO) and Methylprednisolone (IV)
Þ Indication: short-term to reduce inflammation; long-term for immunosuppression
Þ Administration Considerations:
o NEVER abruptly stop
o Use lowest dose possible to control disorder and taper when feasible
o May require concurrent treatment for OSTEOPOROSIS or HYPERGLYCEMIA
o Regularly monitor for development of symptoms of adrenal suppression
o Contraindicated in patients w/ untreated systemic infections
Þ Side Effects:
o Fluid and electrolyte imbalances
o Increase in blood glucose
o Development of Cushing’s Syndrome
o May mask some signs of infection and new infections may appear

80
Q

Thyroid disorders and treatment

A

. Thyroid disorders and treatment
Hypothyroidism: Increased TSH and decreased T3 and T4
Symptoms/ signs: thin hair, enlarged thyroid gland, puffy face, dry/coarse skin, constipation, poor appetite, slow HR, infertility, carpal tunnel syndrome, cold/swelling in limbs, loss of eyebrow hair, weight gain, poor memory, fatigue
Treatment: Levothyroxine
MOA: replaces absence of T3 and T4 to improve metabolic and homeostatic functions.
Indications: hypothyroidism
CI: hyperthyroidism, hypersensitivity
SE/AE: nervousness, tremors, insomnia, tachycardia, palpitations, dysrhythmias,
Angina
NC: monitor heart rate, BP, CV symptoms, symptoms of hyperthyroidism and hypothyroidism and bone mineral density

Hyperthyroidism: decreased TSH and increased T3 and T4
Symptoms: Graves disease, goiter, eyelid retraction, exophthalmos, nervousness, weight loss, emotional lability, excessive sweating, heat intolerance, palpitations, frequent bowel movements, proximal muscular weakness and tremor 
Treatment: Propylthiouracil
MOA:Block synthesis of thyroid hormones
Indications: hyperthyroidism
CI: hypersensitivity, breastfeeding
SE/AE: agranulocytes, edema, skin changes, GI distress, drowsiness, headache, hepatic damage, 
NC: monitor cardiac, observe for hypothyroidism, watch for rash, lupus, agranulocytosis
81
Q

H2 antagonist

A

also known as H2 blockers or H2RAs, are a class of drugs that reduce the amount of stomach acid produced
famotidine : drug

82
Q

Proton pump inhibitor

A

Medication – Pantoprazole
MOA - Blocks the secretion of hydrochloric acid at the proton pump
Indications - GERD, erosive esophagitis, Prophylactic with surgery, In combination with antibiotics for H.Pylori infection, Short-term treatment of active duodenal ulcers
AE – Headache, Abdominal pain, diarrhea or constipation, Acute renal dysfunction, Long-term: Osteoporosis & bone fracture, Potential zinc, magnesium, or B12 deficiency, Immediately report signs of bleeding ulcers such as coughing/vomiting of blood
NC - Available orally, with an NG tube, or as IV injection in the hospital setting, Can be taken with or without food

83
Q

Mucosal protectants

A

(Sucralfate)
Coat any injured area in the stomach to prevent further injury. Promotes ulcer healing. Contraindications: Renal failure or dialysis. AE: constipation. Administer on empty stomach, 1-2 hours before meal.

84
Q

Constipation drugs

A

psyllium (Metamucil) (Class : Fiber supplements)
Absorb water
Safest class of laxatives
Commonly used to treat chronic constipation
May decrease absorption of some drugs
Dissolve with 8 oz water

Docusate (Colace) (Class : Stool softener)
Absorb water and fats into stool to make it soft
Used to prevent constipation
SE: Abdominal cramping

Milk of Magnesia / polyethylene glycol (MiraLAX) (Class : Osmotic laxative)
Increases bowel movement by causing water to be retained with stool
Uses: Purging of toxins, For fecal impaction

Bisacodyl (Dulcolax) (Class : Stimulant laxative)
Often used as bowel prep
BM within 1 hour
Do not take bisacodyl with milk or antacids
Available as oral or rectal suppository

85
Q

nausea drugs

A

Anticholinergics: Scopolamine
Used in combination to treat emesis induced by chemotherapy
Dopamine antagonists: Metoclopramide (Reglan)
Available PO, IM, or IV
MOA: Blocks dopamine receptor to improve nausea
SE: CNS depression (drowsiness, fatigue)
Severe SE: Tardive dyskinesia or neuro-malignant syndrome
Interactions: Alcohol, narcotics, tranquilizers
Serotonin antagonists: Ondansetron (Zofran)
Oral disintegrating, PO, or IV
Indications: Used to manage nausea and vomiting, prevention of surgery and chemo hyperemesis
Interactions: None

86
Q

UTI (cystitis/pyelonephritis) and treatment

A

Uncomplicated
Trimethoprim-sulfamethoxazole
- Standard therapy in women
- Inhibit bacterial synthesis
Nitrofurantoin
- Treatment for UTI caused by E. coli
- Disrupt cell metabolism
Second-line agents :
-Flueroquinoones (ciprofloxacin and levofloxacin)
-Broad-spectrum antibacterial agents
-Avoid antacids
Treatments of complicated UTIs
-Fluoroquinolones (first line)
- IV treatments with antibiotics
-IV hydration

87
Q

Vaginal infections and STI treatment

A

Candida albicans vaginitis (vaginal yeast infection)
Abnormal vaginal discharge caused by yeast
Not sexually transmitted
Treated by: Oral Fluconazole (diflucan)
Bacterial Vaginosis
Abnormal vaginal discharge caused by anaerobic bacteria and high vaginal pH
Not sexually transmitted
Treated by: Metronidazole
STIs
HPV, cervical cancer
Genital warts
Herpes (acyclovir)
HIV infections = antiretroviral therapy
Gonorrhea = treated by Ceftriaxone
Chlamydia = treated by Doxycycline
Trichomonas = treated by Metronidazole

88
Q

Oral contraceptives

A

Estrogen/Progestin Combinations OCP pills:
MOA: Suppress LH and FSH inhibiting ovulation; alters cervical mucus and endometrium
-ovaries become smaller
Indication: Contraception, abnormal uterine bleeding, endometriosis, polycistic ovarian syndrome, acne
SE: -Breakthrough bleeding
-Nausea
-Breast tenderness
-Hypertension
Instructions: Start day 1 of menstrual cycle, take daily, smoking increases risks for blood clots
Contradictions: Smoking, High BP, Heart disease, Breast and cervical cancer, migraine headaches

89
Q

Medroxyprogesterone IM

A

Every 90 days
Pros- no estrogen
Cons- delay in return to fertility (6-12 months), amenorrhea, weight gain, HA, acne
BBW- use for 5+ years cause reduced bone mass density of lumbar spine and femoral neck

90
Q

Magnesium sulfate

A

:smooth muscle relaxant to decrease uterine contractions. SE: sweating, confusion, flushing, nausea
indication: preterm labor, NI: monitor the patient for adverse effects, ensure the drug is working as expected, and monitor the patient’s vital signs

91
Q

Misoprostol

A

indication: Cervical ripening and to stop
postpartum hemorrhage NI/CE: only used in hospital, wait > 4 hours before oxytocin
CI: Uterine rupture or uterine, hyperstimulation, Needs to be on fetal monitor to assess contractions and fetal heart rate, used when cervix is not favorable

92
Q

oxytocin

A

Used to induce labor if cervix is “favorable”. Causes uterus muscles to contract. IV or IM. Can cause arrhythmia, hypertension, fetal bradycardia, nausea, vomiting, and uterine rupture

pharmacology (10 decks)

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