TEST 2 PHARMACOLOGY EXAM PRACTICE
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Questions and Answers

What is the antidote to cholinergic drugs?

  • Norepinephrine
  • Epinephrine
  • Dopamine
  • Atropine (correct)

    • Which drug is used before surgery to prevent aspiration?

  • Anti-Cholinergics (correct)
  • Flomax
  • Atropine
  • Methadone

    • What are the adverse effects associated with ACE inhibitors?

  • Productive cough
  • Bradycardia
  • Hypertension
  • Dry, Non-productive cough (correct)

    • How do Clonidine and Methaladopa lower blood pressure?

    <p>By vasodilation</p> Signup and view all the answers

    What is the mechanism of action of dobutamine?

    <p>It increases cardiac output by increasing contractility</p> Signup and view all the answers

    In what situation would you administer dobutamine to a patient?

    <p>When the patient is experiencing cardiac decompensation</p> Signup and view all the answers

    What is the primary effect of positive inotropes on the heart?

    <p>Increases the force of contraction on the heart</p> Signup and view all the answers

    What distinguishes dobutamine from other positive inotropes?

    <p>It increases cardiac output by increasing contractility</p> Signup and view all the answers

    Which of the following is a potential adverse effect of ARBs?

    <p>Hyperkalemia</p> Signup and view all the answers

    What is the recommended patient education related to adrenergic drugs to prevent adverse effects?

    <p>Educating patients about the high risk of fainting with the first dose</p> Signup and view all the answers

    What is the general dietary recommendation for all hypertensive patients?

    <p>Low sodium diet</p> Signup and view all the answers

    What is SLUDGE a toxic effect of?

    <p>Cholinergic drugs</p> Signup and view all the answers

    What is the antidote to cholinergic drugs?

    <p>Atropine</p> Signup and view all the answers

    Which of the following describes the effects of cholinergic drugs?

    <p>Inducing sweating, urination, and diarrhea</p> Signup and view all the answers

    What are potential adverse effects of cholinergic drugs?

    <p>muscle weakness, abdominal cramps, diarrhea, or difficulty breathing</p> Signup and view all the answers

    What is a potential risk associated with the use of anti-cholinergic drugs?

    <p>Heat stroke</p> Signup and view all the answers

    What is an important consideration for patient education regarding adrenic drugs?

    <p>Sit and dangle</p> Signup and view all the answers

    Why is it important to establish baseline vital signs for a patient receiving nonselective adrenic blockers?

    <p>To monitor for side effects such as changes in heart rate and blood pressure</p> Signup and view all the answers

    Which of the following is a potential adverse effect of beta blockers?

    <p>Hypoglycemia</p> Signup and view all the answers

    In what situation would you administer dobutamine to a patient?

    <p>Acute heart failure with severe hypotension</p> Signup and view all the answers

    What distinguishes dobutamine from other positive inotropes?

    <p>It has less effect on blood pressure</p> Signup and view all the answers

    What is the primary action of beta blockers on the body?

    <p>Decrease heart rate and vasodilate</p> Signup and view all the answers

    What is the mechanism through which Clonidine and Methaladopa lower blood pressure?

    <p>Decreasing heart rate and causing vasodilation</p> Signup and view all the answers

    Which adverse effect should a nurse specifically educate a patient about when using beta blockers for hypertension?

    <p>Dry and Non-productive cough</p> Signup and view all the answers

    What is the mechanism of action of beta blockers?

    <p>They lower blood pressure, heart rate, and myocardial contractility and constrict bronchioles</p> Signup and view all the answers

    Which medication is an example of a beta blocker?

    <p>Propranolol</p> Signup and view all the answers

    What distinguishes beta blockers from alpha blockers?

    <p>Beta blockers lower blood pressure, while alpha blockers raise blood pressure</p> Signup and view all the answers

    What is a potential adverse effect associated with beta blockers?

    <p>Excessive vasodilation and hypotension</p> Signup and view all the answers

    What is the potential adverse effect associated with ARBs?

    <p>Hyperkalemia</p> Signup and view all the answers

    Which patient is most likely to be prescribed diuretics for hypertension?

    <p>A patient with no kidney disease, no heart problems, but with risk factors for heart disease</p> Signup and view all the answers

    What is the primary education for patients taking aspirin for hypertension?

    <p>Take with food and water</p> Signup and view all the answers

    Which medication is an example of a nonselective beta blocker?

    <p>Propranolol</p> Signup and view all the answers

    What distinguishes alpha blockers from beta blockers?

    <p>Beta blockers constrict bronchioles and lower blood pressure</p> Signup and view all the answers

    What is the primary therapeutic indication of dobutamine?

    <p>Increasing cardiac output in cardiac decompensation</p> Signup and view all the answers

    What is the primary reason for being cautious when administering nonselective beta blockers to a patient with hypertension?

    <p>They can result in a slow heart rate and low blood pressure</p> Signup and view all the answers

    Which medication is commonly used to reduce heart rate and vasodilate in patients with hypertension?

    <p>Clonidine</p> Signup and view all the answers

    What distinguishes ACE inhibitors from ARBs in the treatment of hypertension?

    <p>ACE inhibitors are associated with a dry, non-productive cough, while ARBs are not</p> Signup and view all the answers

    What is the primary mechanism through which Clonidine and Methyldopa lower blood pressure?

    <p>By reducing the release of norepinephrine from the nerve endings</p> Signup and view all the answers

    Positive inotropes increase the force of contraction on the heart.

    <p>True</p> Signup and view all the answers

    Cholinergic drugs decrease sweating, urination, and diarrhea.

    <p>False</p> Signup and view all the answers

    Atropine is the antidote for the toxic effects of cholinergic drugs.

    <p>True</p> Signup and view all the answers

    if you overdose a patient on anti-cholinergics, the antidote is PHYSOSTIGMINE.

    <p>True</p> Signup and view all the answers

    Antidote for atropine overdose is physostigmine

    <p>True</p> Signup and view all the answers

    Diuretics are the first line of defense for hypertensive patients. Thiazide diuretics are the most commonly used diuretics for hypertension.

    <p>True</p> Signup and view all the answers

    which of the following are used to reverse anticholinergic poisoning? (antidote)

    <p>all of the above</p> Signup and view all the answers

    What are catecholamines?

    <p>all of the above</p> Signup and view all the answers

    Ad drugs are sympathomimetic…..they mimic…..and effect SNS.

    <p>True</p> Signup and view all the answers

    Catecholamines mimic so they are sympathomimetic

    <p>True</p> Signup and view all the answers

    You have a patient who is 50 and is on a beta blocker, the nurse recognizes that this medication is used for ?

    <p>inhibiting the heart from working hard, Making it easier to pump with less blood pressure.</p> Signup and view all the answers

    The patient has been diagnosed with BPH (benign prostatic hyperplasia) The nurse knows which of the following is primarily used to treat BPH?

    <p>Tamsulosin (flomax)</p> Signup and view all the answers

    with ACE inhibitors and diuretics, your patient education should be on drinking water and preventing dehydration

    <p>True</p> Signup and view all the answers

    A patient walks in and presents with no kidney disease, no heart problems but has a family history and has hypertension. The nurse should prescribe which of the following?

    <p>diuretics</p> Signup and view all the answers

    ACE inhibitors are for renal and hypertension so they are used for diabetic patients

    <p>True</p> Signup and view all the answers

    Match the following

    <p>Alpha blockers end in = SIN or MINE Betablockers end in = LOL PNS = rest and digest SNS = fight or flight</p> Signup and view all the answers

    The mechanism of action for epi or epinephrine is increased hr, bp, and respirations and is used for a code.

    <p>True</p> Signup and view all the answers

    The patient presents with dyspnea and is wheezing turning blue, and constricted lungs. What would the nurse give to this patient?

    <p>Albuterol</p> Signup and view all the answers

    a patient comes in with acute cardiovascular instability, the nurse knows to administer which of the following immediately?

    <p>Epinephrine</p> Signup and view all the answers

    Nursing implications for nasal spray can cause rebound congestion and is addictive.

    <p>True</p> Signup and view all the answers

    Alpha1 in the heart and blood vessels cause vasoconstriction which causes BP, HR, and oxygen demand to increase.

    <p>True</p> Signup and view all the answers

    match

    <p>Propanolol is used for = Hypertension, Anxiety &amp; Headaches Timolol is used for = Interocular pressure and given optically Labatolol and Carval = reduce the Heart rate and vasodilate When you have high blood pressure = you run the risk for developing cardiovascular disease</p> Signup and view all the answers

    The mechanism of action in alpha-blockers is used for Hypertension medication and vasodilation by arterial and venous dilation, reducing peripheral vascular resistance and blood pressure (BP)

    <p>True</p> Signup and view all the answers

    a patient walks into the ER in shock because he accidentally took a week's worth of his Alzheimers (cholinergic medication ). The nurse would expect which treatment?

    <p>Atropine</p> Signup and view all the answers

    The nurse recognizes that high blood pressure in a patient over 60 is:

    <p>150/90</p> Signup and view all the answers

    The nurse recognizes that patients who have chronic kidney disease, diabetes or younger than 60 are to be considered high blood pressure when their bp reads:

    <p>greater than 140/90</p> Signup and view all the answers

    Cholinergic-blocking drugs dry you out – decreased pooping, peeing, crying, sweating.

    <p>True</p> Signup and view all the answers

    Albuterol is used for a more acute situation whereas Salmeterol is used for maintenance.

    <p>True</p> Signup and view all the answers

    Respiratory indications for Adrenic drugs stimulate beta2-adrenergic receptors of bronchial smooth muscles, causing relaxation, resulting in bronchodilation

    <p>True</p> Signup and view all the answers

    Cholinergic drugs stimulate pupils (miosis, reduced intraocular pressure), intestines & bladder (increased gastric secretions, increased gastric motility, and increased urinary frequency), and your sweat glands (increased salvation and sweating)

    <p>True</p> Signup and view all the answers

    The nurse recognizes that Gingko is used for:

    <p>all of the above</p> Signup and view all the answers

    Gingko may cause GI upset, headache, bleeding

    <p>True</p> Signup and view all the answers

    Ginkgo may cause potential drug interactions with which of the following?

    <p>All of the above</p> Signup and view all the answers

    The nurse is about to administer an anti-cholergenic, what is the most important a nurse should assess for?

    <p>a history of glaucoma</p> Signup and view all the answers

    Patient with urinary retention and GI obstruction and glaucoma Should be careful taking this anti-cholinergics and should contact their doctor if muscle weakness, abdominal cramps, and diarrhea, or difficulty breathing. Slide 142

    <p>True</p> Signup and view all the answers

    Cholinergic Drugs: Mechanism of Action: Mimic the effects of acetylcholine

    <p>True</p> Signup and view all the answers

    if a patient comes in sweating due to nicotinic receptors from receiving high doses of Cholinergics, which would you

    <p>Topical application because of poor oral absorption</p> Signup and view all the answers

    SLUDGE, which stands for salivation, lacrimation, urinary incontinence, diarrhea, GI cramps, and emesis

    <p>True</p> Signup and view all the answers

    a patient is having difficulty peeing, or urinary retention, from post operative non obstruction the nurse knows to administer which medication?

    <p>Bethanechol (Urecholine)</p> Signup and view all the answers

    Memantine (Namenda) is Not a cholinergic drug

    <p>True</p> Signup and view all the answers

    Pyridostigmine For Myasthenia Gravis (an autoimmune disease)

    <p>True</p> Signup and view all the answers

    match

    <p>cevimeline = Used to treat excessively dry mouth (xerostomia) succinylcholine = Used as a neuromuscular blocker in general anesthesia bethanechol = Increases tone and motility of bladder and Relaxes sphincters in bladder, allowing it to empty Used to reverse anticholinergic poisoning = physostigmine, pyridostigmine, neostigmine</p> Signup and view all the answers

    These are used for treatment of mild to moderate Alzheimer’s disease Donepezil (Aricept) Galantamine (Razadyne) Rivastigmine (Exelon)

    <p>True</p> Signup and view all the answers

    ATROPINE! LEARN IT!! IF A PATIENT IS COMING IN W SEVERE SINUS BRADYCARDIA THEN THE ANSWER IS ATROPINE TO GIVE.

    <p>True</p> Signup and view all the answers

    PAY ATTENTION TO BOLD. IF EXAM HAS A PATIENT W COPD, W DIAGNOSED OR HAD CLASSIC SYMPTOMS -> GIVE A CHOLINERGIC BLOCKER.

    <p>True</p> Signup and view all the answers

    match the cholinergic blocking drugs

    <p>Atropine = bradycardia, ventricular asystole, antidote for anticholinesterase inhibitor toxicity or poisoning, and preoperatively to reduce salivation and GI secretions Dicyclomine (Bentyl) = functional disturbances of GI motility such as irritable bowel syndrome Glycopyrrolate (Robinul) = Blocks receptor sites in the autonomic nervous system that control the production of secretions. Use: preoperatively to reduce salivation and excessive secretions in the respiratory and GI tracts Scopolamine = prevention of motion sickness and to help prevent postoperative, postanesthesia nausea and vomiting</p> Signup and view all the answers

    match

    <p>Oxybutynin (Ditropan) = overactive bladder and antispasmodic for neurogenic bladder associated with spinal cord injuries and congenital conditions such as spina bifida Tolterodine (Detrol) = urinary frequency, urgency, and urge incontinence caused by bladder (detrusor) overactivity Sildenafil and Tadalafil = used for erectile dysfunction impotence means = sexual dysfunction</p> Signup and view all the answers

    Angiotensin-Converting Enzyme (ACE) Inhibitors : Captopril (Capoten) Benazepril (Lotensin) Enalapril (Vasotec) Fosinopril (Monopril) Lisinopril (Prinivil) Perindopril (Aceon) Quinapril (Accupril) Ramipril (Altace) Trandolapril (Mavik)

    ACE lowers blood volume so again they also give your kidneys a break. ACE inhibitors: reduce glomerular filtration pressure Who has a high risk of kidney injury? Diabetics.. A person w diabetes, can be on an ace inhibitors. They end in PRIL.

    <p>True</p> Signup and view all the answers

    . A pt w diabetes has a new prescription for lisinopril she questioned this order because the physician has never told her she has high blood pressure. D- diabetic. 99.9% of diabetics will be on this even though they don’t have high blood pressure.

    <p>True</p> Signup and view all the answers

    ACE inhibitors indications: Hypertension HF (either alone or in combination with diuretics or other drugs) Slow progression of left ventricular hypertrophy after myocardial infarction (MI) (cardioprotective) Renal protective effects in patients with diabetes

    <p>True</p> Signup and view all the answers

    ACE Inhibitor patient education: Educate patients: may cause dizziness, stand up slow.

    <p>True</p> Signup and view all the answers

    Heparin-induced thrombocytopenia (HIT) Type I Gradual reduction in platelets Heparin therapy can generally be continued. Type II Acute fall in the number of platelets (more than 50% reduction from baseline) Discontinue heparin.

    <p>True</p> Signup and view all the answers

    a patient presents with hematuria, melena (blood in the stool), petechiae, ecchymoses, and gum or mucous membrane bleeding. The nurse finds a recent history of heparin and realizes these are toxic effects. What will the nurse administer?

    <p>Intravenous (IV) protamine sulfate: 1 mg of protamine can reverse the effects of 100 units of heparin.</p> Signup and view all the answers

    The nurse notices that a patient is displaying toxic effects of warfarin. What should the nurse do first?

    <p>Discontinue the warfarin</p> Signup and view all the answers

    When warfarin effects were treated previously treated with vitamin K, warfarin resistance will occur for up to 7 days.

    <p>True</p> Signup and view all the answers

    Idarucizumab (Praxbind) is the Specific antidote for dabigatran Reverses the anticoagulant effects for dabigatran for emergency surgery or in life-threatening or uncontrolled bleeding

    <p>True</p> Signup and view all the answers

    the patient asks why she has been put on two anticoagulants .. heparin and warfarin. how should the nurse respond?

    <p>This is because this is bridge therapy and warfarin takes about 7 days to kick in while heparin acts immediately. When those 7 days have passed, you will be taken off the heparin.</p> Signup and view all the answers

    Argatroban is used for HIT, is only given intravenously and Used for active HIT and percutaneous coronary intervention procedures in patients at risk for HIT

    <p>True</p> Signup and view all the answers

    Careful monitoring of the prothrombin time/international normalized ratio (PT/INR). normal (without warfarin) is 1.0 and with warfarin is 2.0-3.5

    <p>True</p> Signup and view all the answers

    aspirin is a big no-no for children and teenagers, if they take it- they run the risk of Reyes syndrome which is swelling in the liver and brain.

    <p>True</p> Signup and view all the answers

    Which can be given as an antidote in case of excessive anticoagulation.

    <p>protamine sulfate</p> Signup and view all the answers

    a patient taking warfarin has a INR of 4.2. Does the nurse recognize this as?

    <p>its too high, give vitamin K</p> Signup and view all the answers

    Study Notes

    Cholinergic Drugs and Antidotes

    • Atropine is the antidote for cholinergic drug toxicity.
    • In cases of anticholinergic overdose, physostigmine is the recommended antidote.
    • SLUDGE is an acronym for a toxic effect of cholinergic drugs: salivation, lacrimation, urinary incontinence, diarrhea, GI cramps, and emesis.

    Surgery and Aspiration

    • Glycopyrrolate is used preoperatively to minimize the risk of aspiration during surgery.

    ACE Inhibitors

    • Common adverse effects include cough, hyperkalemia, and renal impairment.
    • Patient education should include warnings about potential dizziness and the importance of hydration to prevent dehydration.
    • ACE inhibitors provide renal protective effects, particularly for diabetic patients.

    Blood Pressure Medications

    • Clonidine and Methyldopa reduce blood pressure by central nervous system action, decreasing sympathetic outflow.
    • Positive inotropes, like dobutamine, increase heart contractility and improve cardiac output.
    • Dobutamine is used particularly in cases of acute heart failure or cardiogenic shock.
    • Distinguishing feature of dobutamine compared to other inotropes is its balanced mechanism that stimulates both beta-1 and beta-2 receptors.
    • Beta blockers primarily reduce heart rate and myocardial oxygen demand, and also lower blood pressure.

    Beta Blockers

    • Potential adverse effects of beta blockers include bradycardia, fatigue, and dizziness.
    • Cautious administration of nonselective beta blockers is necessary in patients with respiratory conditions like asthma.
    • Important to establish baseline vital signs when using beta blockers to monitor changes in heart rate and blood pressure.

    Dietary Recommendations

    • General dietary advice for hypertensive patients includes a low-sodium diet and maintaining adequate hydration.

    Anticholinergic Drugs

    • Cholinergic-blocking drugs can lead to decreased bodily secretions (e.g., urine, sweat), causing urinary retention and constipation.
    • Patients with specific conditions, like urinary retention or GI obstruction, must be cautious when using anticholinergics.

    Diuretics

    • The first-line treatment for hypertension, with thiazide diuretics being most commonly prescribed.

    Other Pharmacological Information

    • Catecholamines are sympathomimetic agents that mimic the effects of sympathetic nervous system activation (e.g., increased heart rate, bronchodilation).
    • For patients with a history of chronic illnesses, ACE inhibitors are typically combined with diuretics to manage hypertension effectively.

    Specific Drug Class Information

    • Examples of ACE inhibitors include lisinopril, enalapril, and ramipril; they lower blood volume and glomerular filtration pressure.
    • Ginkgo biloba is noted for potential gastrointestinal upset and drug interactions, especially related to anticoagulants.
    • Albuterol is utilized for acute bronchospasm, while Salmeterol is maintained for long-term control of asthma.

    Anticoagulants

    • Key information regarding anticoagulant therapy includes monitoring PT/INR levels and understanding the implications of elevated INR, which indicates a higher risk of bleeding.

    Heparin and Warfarin Guidelines

    • Recognize that severe side effects of anticoagulants may necessitate immediate intervention, including administration of antidotes.
    • The common complication associated with aspirin in children under 18 is Reye's syndrome, leading to liver and brain swelling.

    Patient Education

    • Educate patients about the importance of reporting side effects and adhering to the prescribed treatment regime, especially concerning antihypertensive and anticoagulant medications.

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