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• The document breaks down questions and study guide for NURS 322 Pharmacology Exam 1

Rights of Medication Administration

• Right drug
• Right documentation
• Right dose (right reason/indication)
• Right time (right to refuse)
• Right route
• Right patient
• Understand and apply these rights

Nursing Process in Medication Administration

• Assessment: What does the medication do?
• Diagnosis: Why are they taking it?
• Planning: Patient-centered goals
• Implementation: Giving medications
• Evaluation: Go back, did the medication work?

Factors Affecting Absorption of Medications

• Includes various routes such as enteric coated and extended release (SR, SA, CR, XL, XT)

Principles of Pharmacokinetics and Pharmacodynamics

• Pharmacokinetics studies what the body does to the drug, how it moves through the body
• It has four phases: absorption, distribution, metabolism, and excretion
• Absorption involves the movement of a drug from its administration site to the bloodstream
• Bioavailability and the first-pass effect are key considerations
• Routes of administration include enteral, parenteral, and topical
• Distribution is the transport of the drug by the bloodstream to its site of action
• Albumin binds to protein in medications
• Metabolism involves the biochemical alteration of the drug into an inactive, more soluble metabolite
• Organs involved in metabolism: liver, skeletal muscles, kidneys, lungs, plasma, and intestinal mucosa
• Excretion is the elimination of drugs through the body, primarily via the kidneys, liver, and bowel
• Half-life is the time required for 50% of the drug to be removed from the body
• Onset of action is the time required for a drug to elicit a therapeutic response
• Duration of action is the length of time the drug concentration elicits a therapeutic response
• Peak level represents the highest blood level of a drug
• Trough level represents the lowest blood level of a drug
• Toxicity occurs when the peak blood level is too high
• Pharmacodynamics studies what the drug does to the body
• Mechanisms of action include receptor interactions, enzyme interactions, and nonselective interactions

Pharmacotherapeutics

• Clinical use of drugs to prevent and treat disease, includes:
• Acute - sustain life, treat disease
• Maintenance - prevent disease progression
• Supplemental - supply drugs to maintain normal function
• Palliative - relieve symptoms
• Supportive - maintain body function while recovering
• Prophylactic - preventative

First-Pass Effect

• Applies only to oral medications given through the gastrointestinal tract
• The drug absorbs into the stomach and then goes through the liver, where it is metabolized and broken down
• Results in decreased bioavailability once in the bloodstream

Medication Considerations Across the Lifespan

• Pregnancy: Drugs cross the placenta by diffusion (category A-X)
• Breastfeeding: Infants face increased risk for drug exposure through the mother's milk; assess risk-to-benefit ratio
• Pediatric & neonate: Immature organs, thin and permeable skin, lack of stomach acid, weaker mucus barriers in lungs, less regulated body temperature, and impaired liver/kidney function affect drug metabolism/excretion
• Dosage should be weight based
• Older adults: High medication use, polypharmacy, noncompliance/nonadherence, chronic illnesses, sensory and motor deficits are common
• Culture: Ethnicity influences genetics, drug response(drug polymorphism), health beliefs, practices, and environmental/economic considerations

Controlled Medications

• Controlled Substance Act of 1970: Establishes schedules and regulates drugs with high abuse potential, requires double-locking and counting by two nurses
• Schedules range from 1 to 5 based on abuse potential: Schedule 1 drugs have no medical use and high abuse potential

Medication Errors

• Organizational, educational, and sociologic issues, abbreviations, and look-alike/sound-alike medications can lead to errors
• Prevention: Use technology (CPOE, barcode), legibly written prescriptions, authoritative resources (pharmacists, drug references), three medication checks, questioning unclear orders, avoiding deciphering illegible orders, assessment, two-patient identifiers, and minimizing verbal orders
• Report errors by assessing and protecting the patient, reporting the error, and documenting the incident

Patient Education Principles

• Medication reconciliation
• Assess patient learning needs, facilitators/barriers, health literacy, and beliefs
• Implementation: Employ the teach-back method, considering age-related changes, culture, and language, ensuring safe medication use at home with materials at an 8th-grade reading level
• Evaluation: Confirm learning by asking questions, requesting a return demonstration, and observing behavior and complications

OTC Drugs

• May interact with other medications and can be potentially abused
• Nonprescription drugs are for short-term use for minor illnesses
• Herbal/dietary supplements: Oral alternative medicines
• Herbs are natural but these require no FDA approval

Drugs Affecting the Central Nervous System

• CNS and neurotransmitters include Acetylcholine, Histamine, GABA, Glutamate, Oxytocin, Vasopressin, Dopamine, Serotonin, Epinephrine, Norepinephrine
• ANS neurotransmitters include Epinephrine (adrenergic) and Norepinephrine (adrenergic)
• Fight or flight response is sympathetic
• Acetylcholine is cholinergic and Dopamine is present
• Sympathomimetic drugs mimic the actions of the sympathetic nervous system
• Catecholamines include Norepinephrine, Epinephrine, and Dopamine
• Are broken down by MAO and COMT
• Sympathetic (Adrenergic NE)
• Alpha 2: Predominant response: vasoconstriction, CNS stimulation
• Beta 12: Bronchial, GI, & uterine relaxation, cardiac stimulation
• Beta 1: heart
• Beta 2: bronchioles
• Parasympathetic (Cholinergic Ach): Nicotinic, Muscarinic: located in muscles
• Nociception receptors: Mu, Kappa, Delta
• Gate theory of pain transmission involves tissue injury releasing bradykinin, histamine, potassium, prostaglandins, and serotonin, initiating nerve impulses via nociceptors toward the dorsal horn of the spinal cord and then to the CNS

Opioid Overdose

• Signs and symptoms: Respiratory depression
• Administer an opioid antagonist

Opioid Agonists

• Drugs: Fentanyl, Hydromorphone (Dilaudid), Meperidine hydrochloride (Demerol), Methadone (Dolophine), Morphine sulfate (MSContin SR), Codeine sulfate, Oxycodone (Oxycontin SR, Oxy IR, Percocet), and Hydrocodone (Vicodin, Norco)
• Side effects relate to effects in areas other than the CNS
• Slowed peristalsis: constipation, Nausea and Vomiting are related
• Histamine release: Pruritus, flushing, and orthostatic hypotension are side effects
• CNS depression: Respiratory depression, sedation, hypotension, bradycardia, and urinary retention are side effects
• Interactions: Other CNS depressants: such as alcohol and antihistamines, Barbiturates, Benzodiazepines, and MAOIs

Opioid Agonist-Antagonists

• Such as Butorphanol (Stadol) and Nalbuphine (Nubain)

Opioid Antagonist

• Drugs: Naloxone (Narcan) and Naltrexone
• Side effects: Withdrawal symptoms, blood pressure changes, dysrhythmias, and nausea/vomiting

Non-Opioid Analgesics

• Drugs: NSAIDs, Tramadol (Ultram), and Acetaminophen (APAP, Tylenol)
• Reversal: acetycysteine
• Contraindications: Acetaminophen: liver disease
• Tramadol: Sensitivity to opioids
• Nursing Implications: Acetaminophen: 4000 mg/daily limit
• Assess for Alcohol use
• Pain assessment
• VS (Acetaminophen: temp, Tramadol: RR)
• Tramadol schedule: class 4

Malignant Hyperthermia

• Signs and symptoms: Genetically linked metabolic disorder related to anesthesia, rapid rise in body temperature, speed up, muscular rigidity (Diaphragm)
• Treatment: Dantrolene

Anesthetics

• General Anesthetics: Etomidate (Amidate), Ketamine (Ketalar), Dexmedetomidine (Precedex), and Propofol (Diprivan)
• Nitrous oxide "laughing gas"
• Moderate Procedural/Conscious Sedation: Morphine (opioid analgesics), Fentanyl (opioid analgesics), Midazolam (Versed) (Benzodiazepines), Diazepam (Benzodiazepines), Barbiturates, Propofol
• Local Anesthetics: Lidocaine (Xylocaine, Lidoderm), Prilocaine/Lidocaine (EMLA), Benzocaine (Dermoplast, Lanacane, Solarcaine), Procaine (Novocaine), Cocaine
• Neuromuscular Blocking Drugs such as Succinylcholine (Anectine, quelcinin), Recuronium (Zemuron)

Muscle Relaxants

• Indications for muscle relaxants: Relief of painful muscle spasms
• Dantrolene is for muscle spasms accompanied with malignant hyperthermia
• Drugs: Baclofen (Lioresal), Cyclobenzaprine (Flexeril), Dantrolene

Insomnia Treatments

• Benzodiazepines for short-term: Diazepam (Valium), Temazepam (Restoril), Clonazepam (Klonopin), Alprazolam (Xanax), Lorazepam (Ativan), Midazolam (Versed)
• Nonbenzodiazepines for long-term: Eszopiclone (Lunesta), Zolpidem (Ambien), Ramelteon (Rozerem)
• Signs and symptoms of benzodiazepine overdose: Working too well/CNS too depressed

Benzodiazepines

• Indications: Sedation, sleep induction, relief of agitation, anxiety-related depression, skeletal muscle relaxation, and acute seizure disorders (status epilepticus)
• Side effects: CNS Depression, drowsiness, dizziness, cognitive impairment, lethargy, "hangover" effect -Interactions: CNS depressants, alcohol, and opioids, Grapefruit, Herbal supplements: Kava, valerian
• Nursing Implications: Monitor for signs and symptoms of overdose, pt safety measure, Diazepam IV: administer slowly, don't mix w other drugs, bigger veins, >1min for every 5mg, gradual weaning period, pt education
• Ambien: take 30-60min prior to HS on empty stomach, no crushing

Antiepileptic Medications

• Barbiturates: Drugs: "-barbital" such as Phenobarbital, Primidone (Mysoline), Pentobarbital (Nembutal), Secobarbital (Seconal)
• Indications: Sedation, anesthesia adjunct, and seizures are reasons
• Contraindications such as respiratory difficulties stimulating PNS as well as pregnancy and severe liver/ kidney disease
• Side Effects: Drowsiness, dizziness, paradoxical restlessness,Gl upse
• Suicidal thoughts as a possible effect
• Hydantoins, Drugs: "-toin" such as Phenytoin (Dilantin), Fosphenytoin (Cerebyx)
• Indications: Seizures
• Contraindications: Bradycardia, Pregnancy
• Side effects: Lethargy, mental confusion, ataxia, gingival hyperplasia, Gl upset, Diltantin facies, Thrombocytopenia, agranulocytosis, Suicidal thoughts
• Iminostilbenes
• Drugs: "-azepine", Carbamazepine (Tegretol, Carbatrol), Oxycarbazepine (Trileptal)
• Indications: Seizures
• Contraindications: Bone marrow depression, liver disease, Pregnancy
• Side Effects: Neurologic Effects: Headache, ataxia, nystagmus, blurred vision, Suicidal thoughts, Gl upset, Bone marrow suppression
• Miscellaneous Drugs: "Gabapentin (Neurontin), Pregabalin (Lyrica), Lamotrigine (Lamictal), Levetiracetam (Keppra), Topiramate (Topamax), Valproic acid (Depakote, kepakene)
• What is the preferred medication treatment for status epilepticus? Benzodiazepines

CNS Stimulants

• Indication, side effects, and nursing implications of CNS stimulants
• Amphetamines & Related stimulants: Drugs: ADHD & Narcolepsy: methylphenidate (Ritalin), Atomoxetine (Strattera)
• Atomoxetine is the first nonstimulant drug approved for ADHD
• Side effects: Hypertension, Tachycardia, Suicidal thoughts, Anxiety, insomnia, Increased metabolic rate, Gl upset, dry mouth, weight loss
• Nursing implications: Drug holidays to diminish addictive tendencies, Addictive potential, VS, cardiac assessment Individualized scheduling based on pts needs
• Antidepressant Drugs/Serotonin Receptor Agonists", Drugs" "-triptan

Parkinson's Drugs

• Mechanism of action, side effects, contraindications, and evaluation
• Indirect – acting dopaminergic Drugs:, Drugs
• MAOIs: "-giline”, Rasagiline (Azilect), Selegiline (Eldepryl, Zelapar)
• Dopamine Modulator: Amantadine (Symmetrel)
• COMT inhibitors: Entacapone (Comtan), Talcapone (Tasmar)
• Mechanism of action: MAOIs: inhibit the breakdown of dopamine, which increases dopamine levels Modulator: causes release of dopamine from storage sites in presynaptic nerve cells.
• COMT inhibitors: block COMT which blocks breakdown of catecholamines Nursing implications, indications, mechanism of action, and side effects of psychotherapeutic drugs

Anxiolytic Drugs

• Drugs: Benzo's and Buspirone(BuSpar)
• Benzodiazepines: Depress areas in CNS(Hypothalamic, thalamic, limbic systems) via GABA receptors
• Buspirone: Agonist activity at serotonin and dopamine receptors
• Indications: Anxiety
• Side effects: paradoxical anxiety, headache, nausea etc.
• Labs: CBC, Electrolytes, hepatic/renal function
• Orthostatic BP & safety factors
• Neuro & mental health assessment

Mood-Stabilizing Drugs

• Lithium: stabilizes
• Bipolar disorder (mania)
• Lithium ions: alter sodium transport in nerve cells, which decrease catecholamines (epi, norepi, dopamine)
• Monitor Na levels & dietary intake
• Monitor Lithium level (0.6-1.2)

Anti-Psychotic Drugs

• Block dopamine receptors in the brain in association with s/s of mental illness, emotion, cognitive function and motor, which decreases dopamine concentration in CNS and produces tranquilizing effect
• Take 7-14 days to therapeutic level
• Agranulocytosis, hemolytic anemia, endocrine symptoms (insulin resistance, weight gain, metabolic syndrome)
• Drowsiness, hypotension, Weight gain, extrapyramidal symptoms, tardive dyskinesia, Neuroleptic malignant syndrome
• Monitor for suicidal ideation
• Cardiac assessment
• Monitor for suicidal ideation and cardiac assessment

Anti-Depressants

• TCAS: correct imbalance in serotonin and norepinephrine by blocking presynaptic reuptake, which makes them more available for SSRIs, inhibit reuptake of serotonin and SNRIs, inhibit reuptake of serotonin and norepinephrine. -Side effects: weight gain sexual dysfunction etc. is possible but not always present
• SSRIs: Highly likely to cause Serotonin syndrome if they re taken with MAO
• Nursing Considerations: Dose low and increase slowly Monitor mental status and suicidal ideation