Pharmacology Course Quiz

Adverse Effects (AE) and Introduction to Pharmacology

• AE stands for adverse effects
• Introduction to Pharmacology (7 questions)
• Prototypes-education
• Supplements – patient education
• Mechanism of action
• Drug classification
• FDA approval process
  • Preclinical: exploring if and how a new drug may work
  • Phase I: exploring safety and dosing of the drug
  • Phase II: exploring the effectiveness of the drug
  • Phase III: Comparison to currently available treatments
  • Phase IV: evaluate drug over time in a large number of patients
• Route of administration – nursing interventions
• Pharmacokinetics
• Complementary & alternative medications
• Medication Error

GI System Medications

• GI System medications (9 questions)
• Antihistamines:
  • Mechanism of action
  • Nursing interventions
• Metoclopramide:
  • Mechanism of action
  • Prokinetic agent: increases Gl motility
  • Blocks dopamine receptors
  • Adverse effects / nursing interventions
    • AE: (high dose) sedation and diarrhea; tardive dyskinesia
    • Contraindicated with Gl perforation, obstruction, or hemorrhage
• Proton-pump inhibitors (omeprazole) / H2 receptor blockers (cimetidine)
  • Adverse effects

Pneumonia, GI Symptoms, Fractures, Rebound Acid Hypersecretion

• Pneumonia, Gl symptoms; fractures, rebound acid hypersecretion; high dose can increase risk of C. Diff
• Nursing interventions / client education: avoid use in elderly patients, administer 1 hour apart from antacids. Avoid aspirin/other NSAIDs.

Laxatives (osmotic, bulk-forming, stimulant, surfactant)

• Laxatives (osmotic (Magnesium hydroxide), bulk-forming (psyllium), stimulant (bisacodyl), surfactant (docusate sodium))
  • Patient education
  • increase bulk/decrease diarrhea: psyllium
  • stool softener: docusate sodium
  • opioid induced constipation: bisacodyl
  • surgery/bowel prep: magnesium hydroxide. Nursing interventions: renal dysfunction.
  • dehydration

Diphenoxylate with Atropine

• Nursing interventions / overdose
• opioid effects at high doses
• increased risk for megacolon
• administer after each loose stool - do not exceed 16 mg/day
• do not take with alcohol

Vitamins and Orlistat

• Vitamins (Folic acid, vitamin A)
• Orlistat
  • Lipase inhibitor; acts in Gl tract to reduce absorption of fat
  • AE: GI; possible liver damage, acute pancreatitis, kidney stones
  • Interactions with blood thinners and fat soluble vitamins
  • Nursing interventions/ client education

Renal System Medications

• Phenazopyridine (analgesic)
  • Mechanism of action / therapeutic uses

Local Anesthetics

• Local anesthetic for mucosa in urinary tract. (Client education)
• Contraindicated with renal disease, urine will turn a red orange color
• Give wm

Oxybutynin (antispasmodic; muscarinic antagonist)

• Mechanism of action / therapeutic uses
• anticholinergic drug that competes with Ach for binding
• with muscarinic receptors; blocks PNS activity
• Client education / nursing interventions
  • anticholinergic effects (blurry vision, urinary retention, dry mouth, constipation); CNS effects
  • rule out obstructive urinary tract problems; contraindicated in glaucoma, myasthenia gravis, or acute hemorrhage

Bethanechol (muscarinic agonist; non-obstructive urinary retention)

• Mechanism of action / therapeutic uses
  • direct acting parasympathomimetic that bind to muscarinic cholinergic receptors to cause PNS stimulation; mimics effects of acetylcholine

Tamsulosin (BPH medication)

• Nursing interventions / evaluation
  • Avoid after cataract surgery (floppy disk)
  • abnormal ejaculation
  • headache/dizziness
  • little to no effect on BP like other alpha blockers

Nitrofurantoin (antiseptic)

• Adverse effects
  • hypersensitivity
  • blood disorders
  • hepatotoxicity
  • peripheral neuropathy
  • SJS
  • CNS effects (nystagmus, vertigo)

Trimethoprim and sulfamethoxazole

• Adverse effects
  • hypersensitivity
  • SJS
  • hemolytic anemia
  • kernicterus (jaundice in infants)
  • renal damage
  • hyperkalemia
• Nursing interventions / client education
  • take on empty stomach with full glass of water
  • wear sunscreen
  • don't give to pregnant women and infants
  • use caution with renal impairment

Pain and Inflammation (Opioids, Corticosteroids, NSAIDS)

• Pain assessment

• Opioid antagonist (naloxone)

  • Mechanism of action
  • interferes with effects of opioids by competing with receptors
  • Nursing interventions/adverse effects
    • tachycardia, tachypnea, hypertension, vomiting, return of pain

• Corticosteroids (prednisone)

  • Patient education / nursing interventions
    • increased risk for infection (take calcium/vitamin D supplements for risk of osteoporosis)
    • monitor glucose levels
  • avoid abrupt cessation
  • monitor for GI bleeding
  • eat potassium rich foods (hypokalemia)
  • monitor for signs of fluid retention

• NSAIDs

  • avoid alcohol
  • stop 1 week before surgery
  • use acetaminophen for children or patients on anticoagulants

Antimicrobial Treatment (Antibiotics/Aminoglycosides)

• Antibiotic treatment
  • Antibiotics affecting bacterial cell wall:
    • penicillin
    • cephalosporin
    • carbapenem
    • vancomycin
  • antibiotics that inhibit protein synthesis:
    • tetracyclines
    • macrolides
    • aminoglycosides
• Nursing interventions
• Assessment and evaluation

Aminoglycosides (gentamicin)

• Adverse effects
  • muscle weakness
  • respiratory depression
  • irreversible ototoxicity

Penicillin

• Adverse effects
  • anaphylaxis
  • renal impairment
  • hyperkalemia
  • dysrhythmias

Antimycobacterials (isoniazid/rifampin)

• Treatment and nursing interventions
  • only for TB; multi drug therapy to lower potential for resistance
  • longer treatment for active TB; RIPE therapy for 8 weeks, then continuation phase for 4-7 months
  • AE: peripheral neuropathy; hepatotoxicity
  • Orange discoloration of bodily fluids; take vitamin B6 for neuropathy

Amphotericin B (polyene antibiotics)

• Nursing interventions / client education
  • Uses: tx systemic fungal infections
  • AE: bone marrow suppression; nephrotoxicity; hypokalemia; thrombophlebitis, respiratory distress, delirium

HAART therapy for HIV

• 3-4 combination drugs
• treatment continues for life; goal is to reduce plasma HIV to lowest level
• Abacavir/dolutegravir: prevents transmission from pregnant woman to fetus; stops replication.

Vancomycin

• Nursing interventions / client education
  • assess for hearing loss
  • administer SLOWLY
  • monitor BUN/Crt.
  • check trough levels

Adverse effects

- ototoxicity
- vancomycin flushing syndrome: erythema, hypotension, tachycardia, angioedema

Diuretics (Dosage Calculations)

• 5 Classifications: loop, thiazide, potassium-sparing, osmotic, carbonic anhydrase inhibitors
• Nursing interventions/client education
  • high urine output, low BP, daily weights and I&Os
  • monitor electrolytes, BUN, creatinine
  • watch for signs of gout or photosensitivity
  • give early in the day
  • watch for orthostatic hypotension
• Common diuretic AE
  • dehydration/hypotension, electrolyte imbalance (hypokalemia, hyponatremia, hypomagnesemia, hyperglycemia, high uric acid), ototoxicity

Fluid and Electrolytes

• Maintenance fluids
  • hypotonic, isotonic, hypertonic
• Hydration status – dehydration/overhydration
• IV complications
  • types/treatment
• Torsade's causes
• Electrolyte Normal Values – K, Ca, Mg, Na
• Normal Sodium Range: 135-145
• Normal Potassium Range: 3.5-5.5
• Normal Magnesium Range: 1.8-2.6
• Normal Calcium Range: 8.2-10.2

Anesthetics / Local Anesthetics, NMB

• Local anesthetics use/ patient teaching/ADR
  • blocks perception of pain first, then cold, warmth, touch, and deep pressure
  • epinephrine added to constrict blood vessels
  • extend duration of action; reduces risk of toxicity
• AE: rare but include CNS toxicity (excitement to AMS) and cardiovascular
• BLACK BOX: 2% oral products accidental ingestion by children, seizure, brain injury, cardiac abnormalities, and death
• lipid therapy for lidocaine toxicity
• Neuromuscular blocks (succinylcholine) - use/ADR/patient teaching
  • use: binds to Ach at NM junctions, depolarizing, cause paralysis only of muscles
  • AE: apnea, hypotension, malignant hyperthermia, hyperkalemia with cardiac arrest; prolonged with low plasma pseudocholinesterase levels
• General Anesthetics
  • Propofol uses/ADR/patient teaching
    • most used agent for anesthesia, used for induction and maintenance
    • AE: resp. depression/apnea; hypotension/circulatory depression; injection site pain; anaphylaxis; laryngospasm; propofol infusion syndrome; metabolic acidosis; hyperkalemia; renal failure; rhabdo; cardiac failure; treated with ventilation IV fluids and vasopressors
  • Nitrous oxide ideal for short surgical/dental procedures. AE: post op N/V

Immune System/Vaccinations

• Humoral vs cellular immunity
  • humoral: targets invaders outside cells, B cell lymphocyte is activated, memory cells and plasma cells are made, plasma cells secrete antibodies
  • cell mediated: targets defective body cells/transplants, activates other immune cells like macrophages, cytolytic T cells kill infected/cancerous cells.

Hepatitis B vaccine, Titers and Passive vs Active Immunity

• HepB vaccine
  • not a live vaccine
  • 90% effective. - Contraindicated if allergic; symptoms: injection site pain, mild-moderate fever, urticaria (hives); possible anaphylaxis

Interfereon Alfa 2B, Immunosuppressants, Cyclosporine

• Interferon- alfa – 2b
  • treats cancers and viral infections
  • AE: flulike syndrome; N/V and diarrhea; depression/SI!; immunosuppression; hepatotoxicity; neurotoxicity
• Immunosuppressants – function, uses in patients
• Cyclosporine drugs
  • calcineurin inhibitor; used in kidney, heart, liver transplant rejection, psoriasis, and xerophthalmia, ulcerative colitis, or Crohn's disease

Integumentary/Eyes (osteomalacia, osteoporosis, Paget's Disease)

• Osteomalacia, osteoporosis, Paget's disease
  • osteomalacia: softening of bones (Vitamin D/Calcium deficiency)
  • osteoporosis: resorption exceeds deposition; bone becomes fragile
  • Paget's disease: bone resorption and bone deposition occur simultaneously; causes neuro and hearing issues.

Drug Therapies

• Drug therapies (alendronate, calcitriol), calcitriol, hypoparathyroidism, CKD
• AE: hypercalcemia, BACKME, digoxin levels altered; alendronate: bone resorption inhibitor; decreasing osteoclast activity.

Skin infections (Drug Therapies: Permethrin/Tretinoin)

• permethrin: kills lice and mites; not effective to Ova
  • AE: local reactions, itching redness/edema
• tretinoin: acne, fine wrinkles/liver spots
  • AE: blistering, peeling, crusting, burning, edema, sunburn

Open vs. Closed Angle Glaucoma

• Closed angle: rare, unilateral; injury/stress; rapid onset; bloodshot eyes, foggy vision with halos; bulging iris; tx with meds/surgery
• Open angle: common, bilateral; normal aging; asymptomatic; gradual onset; tx with meds

Final Exam Information

• Cumulative final exam: 75 questions
• Worth 10% of overall course grade

Test your knowledge on key concepts related to pharmacology, including exam structure and content breakdown. This quiz will cover various sections and question distributions within the cumulative final exam.