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NCLEX > Pharmacology > Flashcards

Pharmacology Flashcards

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1
Q

Receptor

A

Site on a cell where the medication acts

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2
Q

Agonist

A

The drug has an affinity (or liking) for the receptor - going to cause that receptor to be activated

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3
Q

Antagonist

A

Any drug that binds to a receptor and prevents the activation of a receptor

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4
Q

Half- life

A

How long it takes to get 50% of the drug out of the body. It generally takes 4-5 half-lives to achieve a “steady state” (levels of the drug in the blood are even/maintaining - therapeutic level) or to reduce the drug level to an insignificant amount

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5
Q

LD 50

A

Lethal dose in 50% of the tested population

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6
Q

ED 50

A

Effective dose in 50% of the tested population

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7
Q

Therapeutic Index

A

LD50/ED50 (margin of safety - range) - the lower the range, the less safe the drug is

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8
Q

Drugs with a narrow TI

A

Digoxin, Lithium, Warfarin

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9
Q

What are three special considerations to look out for when administering medications?

A

Grapefruit Juice
Prolonged QT interval
Hepatotoxic

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10
Q

What does grapefruit juice do in the body?

A

Inhibits the enzyme cytochrome P450 in the liver (responsible for metabolizing drugs and preparing them for elimination)

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11
Q

Drugs whose levels are increased by grapefruit juice?

A

Nifedipine (headache, flushing, tachycardia, hypotension)

Verapamil (bradycardia, AV heart block, hypotension, constipation)

Statins: atorvastatin, lovastatin, simvastatin (GI disturbances, headache, liver and muscle toxicity)

Midazolam (increased sedation)

SSRIs: fluoxetine, sertraline (serotonine syndrome)

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12
Q

Why is a prolonged QT interval bad?

A

Danger sign for a life-threatening arrhythmia (Torsades-de-pointes - polymorphic form of VTAC)

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13
Q

Which drugs prolong the QT interval?

A

Ondansetron (Zofran) for nausea and Haloperidol (first generation antipsychotic) are notorious for prolonging the QT interval

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14
Q

Which drugs are hepatotoxic (harmful to the liver)?

A

Statins, anti-seizure drugs, anti-fungal drugs, anti-depressant/antipsychotic drugs, antimicrobials, and acetaminophen (when taken with alcohol or in excess)

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15
Q

Antidote & reversal agents

A

Acetaminophen - Acetylcysteine

Benzodiazepines - Flumazenil

Cyanide Poisoning - Methylene Blue

Digitalis - Digoxin immune FAB

Ethylene Poisoning - Fomepizole

Heparin & Enoxaparin - Protamine Sulfate

Iron - Deferoxamine

Lead - Succimer

Magnesium Sulfate - Calcium Gluconate

Opioids - Naloxone

Warfarin - Vitamin K

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16
Q

Drug-Drug Interactions

A

ACE Inhibitors - Potassium-Sparing Medications (Risk for Hyperkalemia)

Nitroglycerin - Erectile Dysfunction Medications (Risk for Profound Hypotension)

Metformin - Contrast Dye (Risk for Nephrotoxicity)

MAOIs or St. John’s Wort - Other Antidepressants (Risk for Serotonin Syndrome)

17
Q

Drug-Food Interactions

A

Calcium Channel Blockers, Statins, Anticoagulants - Grapefruit Juice (increase levels in the body)

MAOIs - Tyramine Containing Foods (ex. red wine, aged cheeses, salami, chocolate) - risk for hypertensive crisis

Warfarin - Vitamin K (consistent amounts should be consumed daily - leafy greens) - risk for clotting and increasing clotting cascade

18
Q

Drug-Disease Interactions

A

Asthma - Beta-Blockers (bronchospasm)

Chronic Liver Disease - Warfarin (increased sensitivity & bleeding)

CHF - Calcium Channel Blockers, NSAIDs, Steroids (sodium/water retention, increased risk of cardiac events)

Epilepsy - TCAs, antimalarials, antipsychotics (reduces seizure threshold - more prone to having that seizure)

Hypertension - NSAIDs (increased BP due to sodium retention and vasoconstriction)

Parkinson’s Disease - Cox-2 Inhibitors (worsening of Parkinson’s symptoms)

Renal Failure - NSAIDs (nephrotoxicity - hard on the kidneys)

Respiratory Failure - Neuroleptics (respiratory depression)

19
Q

What are the different drugs for pain?

A

Local Anesthetics

Opioid Analgesics (agonists, agonists-antagonists, antagonists)

Non-opioid analgesics (Cox-inhibitors) - NSAIDS and Acetaminophen

20
Q

Local Anesthetics

A

end in -caine
Ex. Lidocaine, Cocaine etc.

21
Q

Lidocaine

A

Therapeutic class: Local anesthetic

Indication: Painful procedures, localized pain/discomfort (pain control in one area)

Action: Stop axonal conduction by blocking sodium channels in the axonal membrane. No conduction = no sensation!

Nursing Considerations:
● Systemic absorption can result in palpitations, tachycardia, and hypertension
● Sometimes used with a vasoconstrictor (like epi!) to limit the absorption of the drug to surrounding tissues

22
Q

Opioid Agonists

A

● Morphine
● Codeine
● Meperidine
● Fentanyl
● Oxycodone
● Hydrocodone
● Hydromorphone
● Oxymorphone
● Methadone (opioid withdrawal)

23
Q

Morphine

A

Therapeutic class: Opioid analgesic

Indication: Pain

Action: Binds to opiate receptors in the CNS and alters perception of pain while producing a general depression of the CNS

Nursing Considerations:
● Common side effect: opioid induced constipation
● CNS depressant (decreased respiration, decreased HR - monitor respiratory rate
● Antidote = naloxone

24
Q

Opioid Side Effects “MORPHINE”

A

M - Miosis (pupil constriction), Mood changes

O - Out of it

R - Respiratory Depression, Reduced Salivation

P - Pruritis, Pneumonia (aspiration)

H - Hypotension, Headache

I - Infrequent Elimination (constipation, urinary retention)

N - Nausea, Nervousness

E - Emesis

25
Q

Methadone

A

Therapeutic class: Opioid analgesic - opioid agonist

Indication: Pain, opioid withdrawal

Action: Binds to opiate receptors in the CNS and alters perception of pain does not cause euphoria

Nursing Considerations:
● Long half-life (doesn’t peak like morphine does)
● Very slowly titrate down

26
Q

Opioid agonist-antagonists

A

● Buprenorphine
● Butorphanol
● Nalbuphine
● Suboxone - common in treating opioid withdrawal

27
Q

Buprenorphine

A

Indication: Mild to moderate pain, opioid addiction

Action: Opioid receptor agonist-antagonist

Nursing Considerations:
● Lower potential for abuse (not getting that euphoric feeling) and less powerful analgesic effects (mild to moderate pain relief)

28
Q

Opioid Antagonists

A

● Naloxone
● Naltrexone
● Methylnaltrexone

29
Q

Naloxone

A

Therapeutic class: Opioid Antagonist

Indication: Treatment of opioid overdose, relief of opioid-induced constipation, reversal of postoperative opioid effect

Action: Blocks the effects of opioid agonists reversing analgesia, sedation, euphoria, and respiratory depression

Nursing Considerations:
● Will cause immediate withdrawal in someone physically dependent on opioids

30
Q

Non-Opioid Analgesics

A

● Cyclooxygenase inhibitors
● Non-Steroidal Anti-Inflammatory Drugs
○ Naproxen
○ Ketoprofen
○ Indomethacin
○ Ibuprofen
○ Ketorolac
○ ASA
○ Celecoxib
● Non-Opioids that DO NOT suppress inflammation
○ Acetaminophen

31
Q

How does COX 1&2 act on body tissues?

A

● Gastric protection
● Vasodilation
● Platelet aggregation
● Maintenance of renal function
● Inflammation/Pain
● Fever/Pain

32
Q

Ibuprofen (Advil)

A

Indication: Inflammation (RA, OA, bursitis), mild to moderate pain, fever

Action: Block prostaglandin which causes inflammation, pain, and fever (prostaglandins are produced by the COX enzyme)

Nursing Considerations:
Side effects:
● Gastric ulceration
● Bleeding - typically avoided in trauma and surgical clients
● Renal impairment - monitor BUN/Cr

33
Q

Acetylsalicylic Acid (ASA - Aspirin)

A

Therapeutic class: Antipyretic, non-opioid analgesic

Indication: Pain (best for joint, muscle, and head pain. Very common in arthritis), fever, protects against thrombotic disorders (MI, stroke prevention).

Action: Inhibits the production of prostaglandins which leads to a reduction of fever and inflammation, decreases platelet aggregation leading to a decrease in ischemic diseases

Nursing Considerations:
● Risk of bleeding
● Caution with pediatric clients - Reye’s syndrome can occur with viral infections (encephalopathy/brain damage). Only time it is commonly used in peds is in Kawasaki’s disease
● Salicylism - ASA toxicity. S/S: tinnitus, sweating, headache, dizziness, metabolic acidosis

34
Q

Acetaminophen

A

Therapeutic class: antipyretic, analgesic - *No anti-inflammatory properties

Action: Inhibit the synthesis of prostaglandins which play a role in transmission of pain signals and fever response

Nursing Considerations:
● Overdose, or taking acetaminophen with alcohol, causes a toxic metabolite to build up. Can cause major liver damage and even death
● Max daily dose = 4g. For long term use - the maximum daily dose is only 3 grams per day!!
● Antidote = n-acetylcysteine

NCLEX (3 decks)

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