Pharmacology

Question 1

Topical Antimicrobials

Answer 1

Indications:
- Applied to the skin to treat a bacterial, fungal, or viral infection
- creams, lotions, oils, ointments, powders, shampoos, and cleansers

Antibacterials
Bacitracin,
Neomycin,
Mupirocin

Antifungals
Clotrimazole, Ketoconazole,
Miconazole,
Nystatin

Question 2

Topical Corticosteroids

Answer 2

Indications:
- Inflammation
- Redness
- Itching

Triamcinolone,
Hydrocortisone

Question 3

Allopurinol

Answer 3

Class: Hypouricemic agent
Indication: Gout

Action: Inhibits xanthine oxidase to prevent uric acid from forming

Nursing Considerations:
- Monitor for side effects of leukopenia, fever, and rash
- Dosage must be individualized
- Teach to avoid foods high in purine
○ Beer, wine, cheeses, beans, anchovies, sardines, liver, kidneys, and cream

Question 4

Calcium

Answer 4

Indication:
- Hypocalcemia
- Dietary supplement

Action: Supplement calcium

Nursing Considerations:
- Monitor for hypercalcemia

Calcium acetate, calcium carbonate (Tums!!), calcium citrate, calcium gluconate

Question 5

Vitamin D

Answer 5

Indication:
* Hypoparathyroidism
* Hypocalcemia
* Vitamin D deficiency
Action:
* Supplements Vitamin D stores
Nursing Considerations:
- Monitor for toxicity - fat soluble
- Osteoporosis, hypercalcemia
- With sufficient exposure to sunlight, the body can manufacture all the vitamin D it needs!!
- Therapeutic responses to vitamin D require adequate calcium intake - encourage intake of foods that are high in calcium

Cholecalciferol, Calcitriol, Ergocalciferol

Question 6

Calcitonin

Answer 6

Indication:
* Osteoporosis
* Paget’s disease
* hypercalcemia
Action:
* Inhibits the activity of osteoclasts and thus decreases bone resorption, and inhibits tubular resorption of calcium, thereby increasing calcium excretion
Side effects:
* Nasal dryness
* Nasal irritation
Nursing Considerations
* Usually administered by nasal spray

Question 7

Alendronate

Answer 7

Class: Bisphosphonate

Indication: Osteoporosis

Action: Decreases bone resorption by osteoclasts Nursing Considerations:

Side effect: Esophagitis

Contraindication: in clients with a pre-existing esophageal disorder!

Nursing Consideration
* Take with a full glass of water
* Remain upright for 30 minutes after taking (do not take supine or lie down after taking)
* If difficulty or pain with swallowing, or heartburn develops, clients should discontinue the medication and contact their provider

Question 8

Baclofen

Answer 8

Class: Centrally Acting Muscle Relaxer
Indication: Muscle spasticity: MS, CP, SCI
Action
* Acts within the spinal cord to suppress hyperactive reflexes involved in regulation of muscle movement
Nursing Considerations
* Monitor for CNS depression
* Do not discontinue abruptly - taper over 1 to 2 weeks
* Can cause seizure

Question 9

Albuterol

Answer 9

Class: Bronchodilator
Indication
* Asthma
* COPD
Action
* Binds to beta2 adrenergic receptors in the airway leading to relaxation of the smooth muscles in the airways
Nursing Considerations
* Be very cautious when using in clients with heart disease, diabetes, glaucoma, or seizures
* Causes tachycardia

Question 10

Terbutaline

Answer 10

Class: Bronchodilator
Indications
* Rescue/relief and maintenance drug for wheezing
* SOB
* Coughing caused by asthma
Action
* Blocks beta 2 adrenergic receptors in the respiratory system to cause bronchodilation by inhibiting the release of hypersensitivity reaction products from mast cells
Side Effects
* Shakiness
* Jitteriness
* Dizziness
* Drowsiness
* Sleep disturbances
* Weakness
* Headache
* N&V
* Tachycardia
* Hypertension
* Hyperglycemia
* CNS overstimulation
Nursing considerations
* Assess HR, BP, EKG, blood glucose
* Can be given orally, SC, or by inhaler
* 4-6 hour duration
* More SE with oral administration because it requires higher dosage
* Teach proper inhaler use

Question 11

Methylprednisolone

Answer 11

Class: Steroids
Indication
* Inflammation
* Allergy
* Autoimmune disorders
Action
* Suppress inflammation and normal immune response
Side effects
* Immunosuppression
* Hyperglycemia
* Osteoporosis
* Delayed wound healing
Nursing Considerations
* Monitor for too much steroid
○ Cushing’s symptoms; buffalo hump

Question 12

Diphenhydramine

Answer 12

Class: Antihistamine
Indication
* Allergy
* Anaphylaxis
* Sedation
Action
* Antagonizes effects of histamine,
* CNS depression
Nursing Considerations
* Monitor for drowsiness
* Anticholinergic effects

Question 13

Enalapril

Answer 13

Class: ACE inhibitor
Indication:
* Hypertension
* CHF
Action:
* Blocks conversion of Angiotensin I to Angiotensin II
* Inc Renin levels and dec Aldosterone levels in Vasodilation
Nursing Considerations:
* D/C if pt develops a dry cough - angioedema
* Monitor BP
* Contraindicated during pregnancy

Question 14

Losartan

Answer 14

Class: ARB
Indication:
* Hypertension
* DM Neuropath
* CHF
Action:
* Inhibits Vasoconstrictive properties of Angiotensin II
Nursing Considerations:
* Monitor BP
* Monitor Fluids
* Monitor Renal & Liver status
* Contraindicated during pregnancy

Question 15

Amlodipine

Answer 15

Class: Calcium Channel Blocker
Indication
* Hypertension
* Angina
Action
* Blocks transport of calcium into muscle cells inhibiting excitation and contraction, causes peripheral vasodilation
Nursing Considerations
* Avoid grapefruit - Blocks the enzyme involved in metabolizing calcium channel blockers, causing their levels to increase
* Monitor BP - orthostatic hypotension
Can cause gingival hyperplasia

Question 16

Propranolol

Answer 16

Class: Beta Blocker
Indication:
* Hypertension
* Angina
* Arrhythmias
* MI
* Cardiomyopathy
* Alcohol withdrawal
* Anxiety
Action:
* Blocks Beta I & II adrenergic receptors slowing HR
Nursing Considerations:
* DO NOT discontinue abruptly, d/c slowly
* Can mask signs of Hypoglycemia (Monitor Blood sugars)
* Caution with Asthma & COPD - cause bronchospasms

Question 17

Amiodarone

Answer 17

Therapeutic class: Antiarrhythmic
Indication: Arrhythmias

Action: Stops potassium from leaving cells and prolongs resting period of heart cycle

Adverse effects:
- dizziness
- tremors
- ataxia
- pulmonary fibrosis
- bradycardia
- heart block
- blue-gray skin discoloration

Nursing Considerations:
● Has iodine and can disturb thyroid
● Not given in pregnancy

Question 18

Adenosine

Answer 18

Class: Antiarrhythmic
Indication
* SVT (Super ventricular tachycardia)
Action
* Slows conduction through AV node, interrupts re-entry through AV node, restoring normal sinus rhythm
* “restarts the heart”
Nursing considerations
* Will be periods of Asystole after admin
* Warn client - will feel like someone kicked you in the chest
* Warn family - they will flatline on monitor
* Rapid push or will not work - follow with 10ml saline
* Use with extreme caution with asthmatics

Question 19

Atropine

Answer 19

Class: Antiarrhythmic; anticholinergic
Indication:
* Excessive secretions
* Sinus bradycardia
* Heart block
Action:
* Inhibits acetylcholine, inc HR, causing bronchodilation and dec secretions

Nursing Considerations:
* Monitor urinary retention
* Monitor constipation
* Avoid in GLAUCOMA

Question 20

Digoxin

Answer 20

Class: Cardiac glycoside
Indication
* Heart failure
* A-fib
* A-flutter
* Cardiogenic shock
Action
* Inc contractility, dec HR
* Acts on cellular sodium-potassium ATPase making heart more efficient
Nursing Considerations
* Monitor for Dig toxicity
* Avoid BLACK LICORICE
Monitor HR (hold <60)

Question 21

Heparin

Answer 21

Class: anticoagulants
Indications
* Strokes
* Chronic a-fib
* Post-operatively
Side Effects
* Bleeding
* Hematuria (pink urine)
* Hematemesis (bloody vomit)
* Bruising
* Down trending H&H
Nursing Considerations
* Monitor for bleeding
Antidote
Protamine Sulfate

Question 22

Low Molecular Weight Heparin

Answer 22

Class: Anticoagulants
Indications
* DVT prophylaxis
Action
* Stops thrombin from being activated, preventing clots from forming
Nursing Considerations
* Always given subQ
* Porcine derived (may have cultural or religious implications)
* No monitor platelets
Only anticoagulant that can be used in pregnancy

Enoxaparin,
Dalteparin,
Tinzaparin

Question 23

Warfarin

Answer 23

Class: anticoagulants
Indications
* Venus thrombosis
* Pulmonary embolism
* A-fib
Action
* Disrupts liver synthesis of VitK clotting factors
Nursing Considerations
* Monitor for bleeding
* Monitor PT and INR
○ PT: 10-12 sec
○ INR: 0.9-1.2
* Contraindicated in pregnancy
Antidote
Vitamin K

Question 24

Aspirin

Answer 24

Class: Anticoagulant
Indication
* Mild to moderate pain
* Stroke prophylaxis
* MI prophylaxis
Action
* Inhibits prostaglandins production to tx fever and inflammation, decreases platelet aggregation leading to decrease clotting
Nursing Considerations
* Risk of bleeding
○ Don’t administer with other anticoagulants
○ D/c 5-7 days prior to surgery
* Caution with pediatric clients
○ Reye’s syndrome can occur with viral infections like the flu or chickenpox: causes vomiting, delirium, coma, and death
○ Only time it is commonly used in peds is in Kawasaki’s disease
* Salicylism = ASA toxicity that causes nausea, tinnitus, headache, delirium, hyperventilation, pulmonary edema then OD causes respiratory depression and acidosis leading to coma and death. Sodium bicarbonate is treatment for acidosis and fluid resuscitation

Question 25

Fibrinolytics/ Thrombolytics

Answer 25

Indications
* Established clots (PE, Ischemic stroke)
Action
* Enzyme converts plasminogen to plasmin, destroying the clot
Adverse Effects
* Hemorrhage
Nursing Considerations
* Must give ASAP (within 4.5 hours)
* Don’t give with other anticoagulants or antiplatelets
* Mild allergic reactions are common
○ Give antihistamine of corticosteroids

Urokinase, Streptokinase, Alteplase

Question 26

Penicillin’s

Answer 26

Class: Antibiotics
Indications
* Infections
Action
* Weakens bacterial cell wall
* Bacteria dies and stops making you sick
Side Effects
* Rash
* Diarrhea
Nursing Considerations
* Low toxicity but common allergic reactions
* Caution in renal patient’s
* Monitor kidney function (BUN, Cr)
Monitor for rash

Question 27

Aminoglycosides

Answer 27

Class: Antibiotics
Indications
* Tx for serious infections caused by gram-neg aerobic bacilli
Action
* Weakens bacterial cell walls killing bacteria
Nursing Considerations
* Ototoxicity - monitor for tinnitus
Commonly used with penicillin’s

Question 28

Fluoroquinolones

Answer 28

Class: Antibiotics
Indications
* Urinary infection
* Respiratory infections
Action
* Stops bacterial DNA replications killing bacteria
Nursing Considerations
* Warning for tendinitis and tendon rupture
* Do not giver under 18 years old
* Can exacerbate muscle weakness in MG
* Phototoxicity
* Give “quins” ALONE
* Cause QT prolongation
* Can cause tendon rupture
Dec effects of Phenytoin

Question 29

Vancomycin

Answer 29

Class: Antibiotics
Indications
* C.Diff
* MRSA
* Tx serious infections with susceptible organism in clients allergic to penicillin
Action
* Inhibits cell wall synthesis, promoting bacterial lysis and death
Nursing Considerations
* Nephrotoxic
* Monitor trough levels
* Red Man Syndrome
○ Flushing, rash, pruritis, urticaria, tachycardia, hypotension
○ Give over 60 min (central line)

Question 30

Immunosuppressants

Answer 30

Indication
* Autoimmune disorders
* Transplant recipients
Action
* Decreases the activity of the immune system
Side effects
* Diarrhea
* N&V
* Anorexia
* Weakness
* Headache
Nursing Considerations
* Makes the client more susceptible to infections
* Talk to the health care provider before receiving vaccinations
* No grapefruit

Tacrolimus,
Sirolimus

Question 31

Immune Globulins

Answer 31

Indication
* Immunodeficiency
* Autoimmune disorders
Action
* Passive immunity through antibody administration
Nursing Considerations
* High risk for a reaction - common to premedicate with acetaminophen and diphenhydramine
Titrated on slowly (especially the first infusion)

IVIG, RhoGAM

Question 32

Phenytoin

Answer 32

class: Anticonvulsants
Indication
* Seizures
Action
* Blocks sustained high frequency repetitive firing of action potentials
Side effect
* Gingival hyperplasia
○ Regular dental check-ups
○ Use soft bristle toothbrush
Nursing Considerations
* Therapeutic level: 10-20 mcg/mL
* Antacids can reduce the effect of phenytoin and should be avoided

Question 33

Acetaminophen

Answer 33

Class: Antipyretic, non-opioid analgesic
Action
* Inhibit the synthesis of prostaglandins, which play a role in transmission of pain signals and fever response
Nursing Considerations
* Max daily dose = 4g
* For long term use - the maximum daily dose is only 3 grams per day!!
* Monitor liver function
Antidote
n-acetylcysteine

Question 34

NSAIDs

Answer 34

Indication
* Pain
* Inflammation
* Fever
Action
* Block prostaglandins which cause inflammation, pain, and fever
Nursing Considerations
* Can cause prolonged bleeding
* Typically avoided in trauma and surgical clients
* Can cause peptic ulcers

Aspirin
Ibuprofen
Ketoprofen
Naproxen

Question 35

Acetylsalicylic Acid (Aspirin)

Answer 35

class: NSAIDs
Indication
* Pain - arthritis;
* Stroke and MI prophylaxis
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
○ Don’t administer with other anticoagulants
○ D/c 5-7 days prior to surgery
* Caution with pediatric clients
○ Reye’s syndrome can occur with viral infections
○ Only time it is commonly used in peds is in Kawasaki’s disease

Question 36

Morphine

Answer 36

Class: opioid
Indication
* Pain
Action
* Binds to opiate receptors in the CNS and alters perception of pain while producing a general depression of the CNS
Side effect
* Constipation
Nursing Considerations
* CNS depressant
○ Decreased respiration, decreased heart rate, etc.
○ Monitor respiratory rate
Antidote: Naloxone

Question 37

Omeprazole

Answer 37

Class: Proton Pump Inhibitor
Indications
* GERD
* Ulcers
Action
* Prevents transports of H ion into gastric lumen, decreasing gastric acid production
Nursing Considerations
* Administer 30-60 min BEFORE meal
Report black, tarry stools

Omeprazole,
Pantoprazole,
Lansoprazole,
Rabeprazole

Question 38

Ondansetron

Answer 38

Class: Antiemetics
Indication
* Nausea/vomiting
Action
* Blocks effects of serotonin on vagal nerve and CNS
Nursing Considerations
* Administer slowly - fast push can cause QT prolongation and VT

Question 39

Total Parenteral Nutrition

Answer 39

What
* Nutrition delivered intravenously
* Also called hyperalimentation
Contains
* Dextrose
* Amino acids
* Electrolytes
Indications
* Enteral nutrition is contraindicated
* Client is not tolerating enteral nutrition
* High risk for aspiration
* GI tract obstruction
Complications
* Infection
* Fluid overload
○ Daily weights
* Hypo/hyperglycemia
○ Give Dextrose 10% at same rate IF run out of TPN
Embolism

Question 40

Famotidine

Answer 40

Class: Antihistamine
Action
* Block the release of histamine. Histamine is found in mast cells within GI mucosa and causes secretion of gastric acid and pepsin when it binds with H2 receptors in the mucosal parietal cells. When blocked, acid secretion is blocked.
Indications
* Short term treatment of gastric and duodenal ulcers,
* GERD,
* Zollinger-Ellison syndrome,
* hypersecretion of stomach acid conditions,
* chronic NSAID/ASA use
* GI distress
Nursing considerations
* Monitor CBC and kidney function
* Can be given with meals
* Peak absorption of famotidine is within 2-3 hrs
* Famotidine is available OTC in lower strengths than prescription dosages. Teach clients to only take as directed and only for a short duration.
* Famotidine is less likely to interact with other drugs like cimetidine and ranitidine do so it is the drug of choice when clients are on multiple drugs like phenytoin and warfarin with therapeutic/toxic levels

Question 41

Sucralfate

Answer 41

Class: Disaccharide sulfates
Indications
* Short-term treatment of duodenal or gastric ulcers,
* peptic esophagitis,
* NSAID/ASA-induced GI damage
Action
* Promotes healing of ulcers by providing a barrier over them. It creates a paste when exposed to hydrochloric acid and binds to proteins that are excreted by damaged cells in ulcerated tissue.
Nursing considerations
· Take on an empty stomach 1 hour before meals or 2 hours after meals and at bedtime; often given up to 4 times a day
· Don’t give within 30 min of antacids as they can decrease the effectiveness of sucralfate
· Use caution giving antacids containing aluminum to clients with kidney failure due to aluminum toxicity
· Monitor blood sugar in diabetics as sucralfate contains sucrose
* Can decrease the bioavailability of warfarin, digoxin, and phenytoin, levothyroxine, and several classes of ABX - separate these drugs from sucralfate for at least 2 hours