Pharmacology for Nursing Practice Final Exam 2024

Pharmacology for Nursing Practice - Final Blueprint Fall 2024

• Exam Details: The exam consists of 60 questions. Students have 1 ½ minutes per question.

The Exam Blueprint

• Core Drug Knowledge and Core Patient Variables: This section covers opioid side effects, assessment, patient teaching, and opioid antidote. Pharmacokinetics is also included. Variables such as age, weight, race, medical history, genetics, diet are examples of patient variables.
• Opioids: Side effects include respiratory depression, central nervous system depression, headache, constipation, increased fluid intake, bradycardia, drowsiness. Narcan is an antidote. Schedules 1, 2, and 3 are related to higher usage and potential for addiction/abuse. Patient teaching should include increasing fiber and avoiding alcohol. Assessment of respiratory and cardiac function is necessary before administering medications.
• Opioid Antidote: Naloxone
• Core Drug Knowledge: Levodopa-Carbidopa: This drug increases dopamine production in the brain. Carbidopa prevents levodopa from breaking down prematurely in the brain, allowing it to reach its target. This is used for Parkinson's patients with daily living activity deficiencies. Levo-dopa is a precursor for dopamine.

Additional Medication Information

• Adverse Effects: Tremor, dizziness, numbness, weakness, agitation, anxiety, anorexia, nausea, vomiting, dry mouth, dysphagia, urinary retention, flushing, cardiac irregularities, psychosis, angle-closure glaucoma, melanoma history, psychosis, peptic ulcer disease, depression, bipolar disorder.
• Drug Contraindications: Some potential contraindications include angle-closure glaucoma, melanoma history, psychosis, peptic ulcer disease, depression, and bipolar disorder

Cystic Fibrosis

• Cystic fibrosis is a hereditary disease that affects the respiratory, gastrointestinal, and reproductive tracts.
• The defective gene is located on chromosome 7.
• Thick secretions accumulate in the lungs. Treatment options include a low calorie, high protein diet, and chest physical therapy.

Parkinson's Disease

• Parkinson's disease is a progressive neurodegenerative disorder primarily affecting movement control.
• It results from the loss of dopamine-producing neurons in the brain, specifically in the substantia nigra.
• Key Characteristics: Lack of coordination, rhythmic tremors (often starting gradually, most noticeable at rest), muscle stiffness (rigidity), extreme slowness in initiating and executing movements (bradykinesia), shuffling gait, drooling, slow slurred speech, mask-like facial expression, difficulty swallowing, choking, aspiration pneumonia, cognitive impairments such as visuospatial discrimination difficulties, memory retrieval problems, and difficulties with planning, organizational, and carrying out tasks.

Other Information

• Traditional antipsychotics and vitamin B6: A potential interaction can cause hypertensive crisis.
• Dopamine-Blocking Medications: A possible cause of Parkinson's symptoms.
• Interaction: Traditional antipsychotics and vitamin B6 can interact, potentially causing a hypertensive crisis.
• Page 4 (Chlorpromazine): Action is suppressing symptoms of schizophrenia. Contraindications include bone marrow suppression, pregnancy/lactation, allergies to phenothiazine, antipsychotic medications, alcohol withdrawal, bone marrow suppression, and CNS depression. Interactions include CNS depressants, antacids, and anti-diarrheals. Precautions include glaucoma, diabetes mellitus, hypertension, prostatic hypertrophy, thyroid, cardiac, and liver disorders.
• Antipsychotic Care Goals: Prioritizing safety and encouraging adherence to the medication regimen are key.
• Lithium Therapeutic Levels: Maintaining levels of 0.6 – 1.2 mEq is crucial; monitoring is essential with diuretic medication combinations. 1.2-1.5: lethargy, CNS/muscle weakness, fine tremors, polyuria, ECG changes, bradycardia are adverse effects as are 2.0-2.5: CNS ataxia, clonic movements, and 2.5+: multisystem organ failure. Hydration is important. Narrow therapeutic window. Monitor vital signs.
• Adverse drug effects (chlorpromazine): Anticholinergic effects include dry mouth, constipation, urinary retention, blurred vision, and tachycardia. Suppressed sexual drive, erectile dysfunction, severe dysrhythmias, dermatitis, photosensitivity, neuroleptic malignant syndrome (NMS) are additional potential adverse effects.
• Amphotericin B (Abelcet, AmBisome): Antifungal. Actions include binding to sterols in fungal cell walls, altering permeability to cause cell death (fungicidal effect) or prevent reproduction (fungistatic effect). Adverse effects include Liver and Kidney Toxicity (monitor closely), Bone Marrow Suppression (close monitoring), dermatological changes (rash).
• Antifungal Medications (general): Potential side effects include renal impairment, bone marrow suppression, GI effects (nausea, vomiting, diarrhea, anorexia), and injection site reactions (pain, phlebitis, or thrombophlebitis).
• Contraindications and Cautions: Pregnancy is a variable. The formulations and dosage vary. Careful differentiation is necessary. Lactation: Not recommended due to risks to neonates.
• Patient Teaching for Systemic Antifungals: Emphasize completing the full course of treatment. Inform patients about taking the medication with food (if applicable). Explain the entire course of treatment.
• Safety Precautions for Antifungal Medications: Apply pressure to bleeding sites; avoid IM injections; do not rub subcutaneous injection sites; Inform patient about risks of drug interactions with other medications, including over-the-counter and herbal supplements. Monitor closely for signs of bleeding, signs of stroke, or clot formation. Explain risk of severe renal toxicity with other medications and that antidotes are available (e.g., Vitamin K for warfarin overdose, protamine sulfate for heparin overdose).
• Warfarin: Vitamin K is the antidote.
• Insulin: Glucagon is the antidote.
• Levothyroxine: Lab monitoring (TSH, T3, T4): Initial dosage of 25 mcg; adjustment based on patient response.
• Hyperthyroid Medication Management: Lower thyroid levels, alleviate hyperactivity, address weight loss. Prevent further exacerbations/avoid complications.
• Anticoagulant Therapy: Explain the purpose and importance of therapy, emphasize taking the medication correctly and possible signs of bleeding (e.g., unusual bruising, nosebleeds, bleeding gums). Discuss dietary considerations, including avoiding alcohol and maintaining a consistent intake of foods high in vitamin K, and stress importance of follow-up appointments for medication adjustments.
• Safety during Anticoagulant Use: Apply pressure to actively bleeding sites; avoid intramuscular injections; do not rub subcutaneous injection sites. Encourage medication adherence and seek medical care immediately for serious complications. Explain that antidotes are available (Vitamin K for warfarin overdose or protamine sulfate for heparin overdose)
• Additional Safety Measures: Apply pressure to any bleeding site; avoid IM injections; do not rub subcutaneous injection sites. Encourage the patient to take the medication as prescribed. Explain the availability of antidotes (e.g., Vitamin K for warfarin, protamine sulfate for heparin overdose).
• Core drug knowledge and core patient variable (Rifampin): Urine, tears, and sweat may be tinged red-orange; it is harmless. Take medication exactly as prescribed even if feeling better; Rifampin is used to treat TB and other bacterial infections. Patient education. Monitor intake/output.
• Core drug knowledge and core patient variable (Gentamicin): Monitor intake and output; potency; narrow therapeutic window; monitor peak and trough levels to prevent accumulation; Monitor BUN and serum creatinine level; patient education on adverse effects, including nephrotoxicity, ototoxicity; teach how to manage side effects.
• Core Drug Knowledge and Core Patient Variables (Lithium): Maintain therapeutic lithium level, monitor signs/symptoms of toxicity (lethargy, tremors, polyuria), provide hydration strategies.
• Core drug knowledge and core patient variable (Digoxin): Monitor for infection; use caution; avoid alcohol; teach patient about digoxin's effects, its importance of continued management, and important interactions.
• Core drug knowledge and Core patient variable (Digoxin & Glipizide): Possible risks, appropriate patient education and teaching, patient monitoring for potential problems, possible risks and patient education.
• Core Drug Knowledge and Core Patient Variables (Acetazolamide): Possible risks, potential complications, monitoring, and patient education.
• Core drug knowledge and core patient variable (Anticholinergic drugs): Discuss constipation as an adverse effect and ways to manage it. Discuss possible problems or concerns about taking the medication.

Prepare for the final exam in Pharmacology for Nursing Practice with this comprehensive quiz covering essential topics such as opioid knowledge, side effects, patient variables, and drug interactions. Hone your understanding of drug pharmacokinetics and the use of antidotes like Naloxone. Get ready to excel by testing your core knowledge on key nursing pharmacology concepts.