NURS 322 Pharmacology Exam 1 Study Guide PDF

NURS 322 Pharmacology Exam 1 Breakdown of Questions & Study Guide Course Content Cognitive Domain Item Type Student Knowledge, Application Analysis, Case Study Alt...

NURS 322 Pharmacology Exam 1 Breakdown of Questions & Study Guide Course Content Cognitive Domain Item Type Student Knowledge, Application Analysis, Case Study Alternative Multiple Learning Comprehension Synthesis, Type Item Choice Evaluation (Matching, Outcome select all that apply, fill in the blank, etc) 3 Nursing Process and Drug Therapy X 3 2 Pharmacologic Principles X X 1 3 6 Lifespan Considerations X X 3 5 Cultural, Legal, and Ethical X 1 Considerations 5 Medication Errors X 2 4 Patient Education X 1 1,3 OTC, Herbal, & Dietary Supplements X 1 1,2,3 Analgesic Drugs & CNS Depressants/ 5 questions Muscle Relaxants (11 points) X X X 5 2,3 Psychotherapeutic Drugs X 1 question (4 points) X X 3 2,3 General and Local Anesthetics X 1 2,3 CNS Stimulants X 2 2,3 Antiepileptic Drugs X 2 2,3 Antiparkinson Drugs X X 1 1 3 Medication Calculation X 5 questions (5 points) Totals 24% 59% 5% 12% 12 points 27 11 points points  Study Guide Pharmacology Basics Understand and apply the rights of medication administration and nursing process in medication administration. Assessment: what does med do? Right drug Right documentation Diagnosis: why are they taking? Right dose (right reason/indication) Planning: pt centered goals Right time (right to refuse) Implementation: giving meds Right route Evaluation: go back, did pill work? Right patient What factors affect the absorption of medications, including various routes? Enteric coated, extended release (SR, SA, CR, XL, XT) What are the principles of pharmacokinetics, pharmacodynamics, and apply these to patient care? Pharmacokinetics: study of what the body does to the drug (how it moves through body) 4 phases: absorption, distribution, metabolism, excretion - Absorption: movement of drug from administration site to blood stream, bioavailability, first pass effect, Route: enteral, parenteral, topical - Distribution: transport of drug by blood stream to site of action (albumin – protein bound meds) - Metabolism: biochemical alteration of drug into inactive metabolite, more soluble. Liver, skeletal m, kidneys, lungs, plasma, intestinal mucosa metabolism organs. - Excretion: elimination of drugs through body. Kidney, liver, bowel. Half-life: time required for 50% of drug removed from body Onset of action: time required for drug to elicit a therapeutic response Duration of action: length of time drug concentration elicits a therapeutic response Peak level: highest blood level Trough level: lowest blood level Toxicity: peak blood level is too high Pharmacodynamics: study of what drug does to body Mechanism of action: receptor interactions, enzyme interactions, nonselective interactions Discuss pharmacotherapeutics and understand different reasons medications may be used. Clinical use of drugs to prevent and treat disease - 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 What is the first-pass effect? Only applies to oral meds/given through GI tract - Absorbed into stomach, goes through liver (some metabolized & broken down), once in blood stream: Decreased bioavailability Discuss considerations for medications across the lifespan and populations (ex-pediatric, older adult, etc). Pregnancy: Drugs cross placenta by diffusion (category A-X) Breastfeeding: infants increased risk for drug exposure consumed by mother, risk-to-benefit ratio Pediatric & neonate: immature organs, skin thin and permeable, lack of stomach acid, lungs have weaker mucus barriers, less regulated body temp and dehydration, immature liver and kidneys impair drug metabolism/excretion, weight based dosage Older adults: older than 65, high use of meds, polypharmacy, noncompliance/nonadherence, increased incidence of chronic illness, sensory and motor deficits Cultural: influence of ethnicity on genetics and drug response, drug polymorphism (effect on pt characteristics), health beliefs and practices, environmental/economic considerations Discuss controlled medications. Controlled substance act of 1970 to establish schedules, heavily regulated drugs b/c of high abuse potential, kept double locked, counted by 2 nurses. Schedule 1-5(lower potential) : Schedule 1 = no medical use, high abuse potential How to avoid medication errors and what to do if an error occurs. Organizational issues, educational system issues, sociologic factors, use of abbreviations, look- alike-sound-a-like medications Prevention: technology (CPOE, barcode), prescribers must write legibly, use authoritative resources (pharmacists, current drug references), 3 med checks, never assume anything, question a med order when in doubt, don’t try to decipher illegibly written orders, assessment, 2 pt identifiers, don’t administer if you didn’t prepare, minimize verbal orders, list indication next to order, learn special administration techniques, listen to pt concern, check allergies and identification Reporting: assess & protect patient, report error, document Discuss principles of patient education regarding medications. Medication reconciliation  Assess: pt learning needs, facilitators/barriers, health literacy & beliefs Implementation: use teach-back method, consider age-related changes, consider cultural and language, safe administration of meds at home (return demo), materials written at 8th grade reading level Evaluation: validate that learning has occurred (ask questions, return demo, behavior (compliance/adherence), occurrence of few complications) What are characteristics of OTC drugs? Can interact with other meds and potential for abuse Nonprescription drugs, used short term for minor illnesses Herbal/dietary supplements: oral for alternative medicine, Herbs: nature Require no FDA approval Drugs Affecting the Central Nervous System CNS and neurotransmitters: - Acetylcholine - Histamine - GABA - Glutamate - Oxytocin - Vasopressin - Monoamines: dopamine (norepinephrine precursor), serotonin, epinephrine, norepinephrine ANS nuerotransmitters: - Epinephrine= adrenergic - Norepinephrine = adrenergic Fight or flight^ (sympathetic) - Acetylcholine= cholinergic - Dopamine Sympathomimetic: mimic actions of Sympathetic nervous system Catecholamines: - Norepinephrine - Epinephrine - dopamine Broken down by: MAO, COMT Sympathetic (adrenergic NE):  - Alpha ½: predominant response: vasoconstriction, CNS stimulation - Beta ½: Bronchial, GI, & uterine relaxation, cardiac stimulation o Beta 1: heart o Beta 2: bronchioles Parasympathetic (Cholinergic Ach): - Nicotinic - Muscarinic: located in muscles Nociception receptors: - Mu - Kappa - Delta Gate theory of pain transmission: - Tissue injury -> release of bradykinin, histamine, potassium, prostaglandins, and serotonin - > initiate nerve impulse via nociceptors - > dorsal horn of spinal cord (gate to send signal to brain) ->CNS -> pain What are the signs and symptoms of opioid overdose? Treatment? Side effects and interactions? S/S: respiratory depression Tx: administer opioid antagonist Opioid Agonist: Drugs: - Fentanyl - Hydromorphone (diluadid) - Meperidine hydrochloride (Demerol) - Methadone (Dolophine) - Morphine sulfate (MSContin SR) - Codeine sulfate - Oxycodone (oxycontin SR, Oxy IR, Percocet) - Hydrocodone (Vicodin, Norco) Side effects: - r/t effects in areas other than CNS o slowed peristalsis: constipation, N/V o Histamine release: Pruritus, flushing, orthostatic hypotension o CNS depression: respiratory depression, sedation, hypotension, bradycardia, urinary retention Interactions: - Other CNS depressants: o Alcohol o Antihistamines o Barbiturates o Benzodiazepines o MAOIs Opioid Agonist-Antagonist: Drugs: - Butorphanol (stadol) - Nalbuphine (Nubain)  - Buprenorphone (buprenex) - Pentazocine (talwin) Side effects: - Similar side effects as opioids, but less bc of partial response - Lower incidence of respiratory depression Opioid Antagonist: Drugs: - Naloxone (Narcan) - Naltrexone Side effects: - Withdrawl symptoms - BP changes - Dysrhythmias - N/V Contraindications and nursing implications of non-opioid analgesics. Drugs: - NSAIDs - Tramadol (Ultram) - Acetaminophen (APAP, Tylenol) o 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 Signs, symptoms, and management of malignant hyperthermia. S/S: Genetically linked metabolic disorder r/t anesthesia - Rapid rise in body temp - Causes everything to speed up - Muscular rigidity (Diaphragm) Treatment: Dantrolene General Anesthetics: Drugs: ▪ Etomidate (Amidate) ▪ Ketamine (Ketalar) ▪ Dexmedetomidine (Percedex) ▪ Propofol (Diprivan)  ▪ Nitrous oxide “laughing gas” Moderate/Procedural/Conscious Sedation Drugs: ▪ Morphine (opioid analgesics) ▪ Fentanyl (opioid analgesics) ▪ Midazolam (Versed) (Benzodiazepines) ▪ Diazepam (Benzodiazepines) ▪ Barbiturates ▪ Propofol Local Anesthetics: Drugs: “-caines” ▪ Lidocaine (Xylocaine, Lidoderm) ▪ Prilocaine/Lidocaine (EMLA) ▪ Benzocaine (Dermoplast, Lanacane, Solarcaine) ▪ Procaine (Novocaine) ▪ Cocaine Neuromuscular Blocking Drugs Drugs: ▪ Succinylcholine (Anectine, quelcinin) ▪ Recuronium (Zemuron) Indications for muscle relaxants. - Relief of painful muscle spasms - Dantrolene: muscle spasms accompanied with malignant hyperthermia] Drugs: ▪ Baclofen (Lioresal) ▪ Cyclobenzaprine (Flexeril) ▪ Dantrolene What medications can be used to treat insomnia? Benzodiazepines: Short Term treatment Drugs: “-pam” “-lam” ▪ Diazepam (Valium) ▪ Temazepam (Restoril) ▪ Clonazepam (Klonopin) ▪ Alprazolam (Xanax) ▪ Lorazepam (Ativan) ▪ Midazolam (Versed) Nonbenzodiazepines: Long term treatment Drugs: ▪ Eszopiclone (Lunesta) ▪ Zolpidem (Ambien) ▪ Ramelteon (Rozerem) What are signs and symptoms of benzodiazepine overdose? Treatment? S/S: working too well/CNS too depressed  - Lethargy - Confusion - Diminished reflexes Treatment: Flumazenil Discuss the indications, side, effect, interactions and nursing implications for various benzodiazepines medications. Indications: - Sedations, sleep induction - Relief of agitation, anxiety-related depression - Skeletal muscle relaxation - Acute seizure disorders (Status epilepticus) Side Effects: CNS Depression - Drowsiness, dizziness - Cognitive impairment, lethargy - “hangover” effect Interactions: - CNS depressants: Alcohol, opioids - Grapefruit - Herbal supplements: Kava, valerian Nursing Implications: - Monitor for s/s of overdose - Pt safety measures - Diazepam IV: administer slowly, don’t mix w other drugs, bigger veins, >1min for every 5mg - Gradual weaning period - Ambien: take 30-60min prior to HS on empty stomach, no crushing - Pt education Administration, nursing implications, and contraindications of antiepileptic medications. Barbiturates: Drugs: “-barbital” ▪ Phenobarbital ▪ Primidone (Mysoline) ▪ Pentobarbital (Nembutal) ▪ Secobarbital (Seconal) Indications: ▪ sedation ▪ Anesthesia adjunct ▪ Seizures Contraindications: ▪ Respiratory difficulties (stimulating PNS) ▪ Pregnancy ▪ Severe liver/ kidney disease Side effects: ▪ Drowsiness, dizziness, paradoxical restlessness ▪ GI upset  ▪ Suicidal thoughts Nursing Implications: ▪ Narrow therapeutic window ▪ Habit forming ▪ Assess Neuro Status ▪ Patient safety measures ▪ Monitor blood levels of Barbiturates ▪ VS: hypotension, respiratory depression ▪ Gradual weaning period ▪ Monitor RBC & Hgb/Hct ▪ IV forms require dilution, give slow (can cause necrosis) ▪ Patient education Hydantoins: Drugs: “-toin” ▪ Phenytoin (Dilantin) ▪ Fosphenytoin (Cerebyx) Indications: ▪ Seizures Contraindications: ▪ Bradycardia ▪ Pregnancy Side effects: ▪ Lethargy, mental confusion ▪ Ataxia, gingival hyperplasia ▪ Diltantin facies ▪ GI upset ▪ Thrombocytopenia, agranulocytosis ▪ Suicidal thoughts Nursing Implications: ▪ Narrow therapeutic index ▪ Toxicity: nystagmus, ataxia, dysarthria, encephalopathy ▪ IV administration: slow IV push, Only dilute in NS, use filter, cardiac monitoring ▪ Neuro assessment & VS 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, GI upset ▪ Bone marrow suppression  Nursing implications: ▪ Narrow therapeutic index ▪ Neuro assessment & VS ▪ Liver Function labs, CBC ▪ Avoid Grapefruit juice – toxicity Miscellaneous Drugs: Drugs: ▪ Gabapentin (Neurontin) ▪ Pregabalin (Lyrica) ▪ Lamotrigine (Lamictal) ▪ Levetiracetam (Keppra) ▪ Topiramate (Topamax) ▪ Valproic acid (Depakote, kepakene) Indications: ▪ Seizures Contraindications ▪ Liver impairment Side effects: ▪ GI symptoms, hepatotoxicity ▪ Suicidal thoughts ▪ Stevens-johnson syndrome ▪ Dizziness, drowsiness Nursing implications: ▪ Doses slowly titrated over several weeks to avoid Stevens johnson syndrome ▪ Narrow therapeutic index ▪ Neuro assessment & VS ▪ Liver function Labs, CBC ▪ Avoid abrupt withdrawal ▪ Avoid carbonated beverages & take with food (Valproic acid for GI symptoms) What is the preferred medication treatment for status epilepticus? Benzodiazepines Indication, side effects, and nursing implications of CNS stimulants. Amphetamines & Related stimulants: Drugs: ▪ ADHD & Narcolepsy: Dextroamphetamine Sulfate + amphetamine aspartate (Adderall) Methylphenidate (Ritalin) ▪ ADHD: Atomoxetine (Strattera) Indication: ▪ ADHD ▪ Narcolepsy Side effects:  ▪ Hypertension, Tachycardia ▪ Suicidal thoughts ▪ Anxiety, insomnia ▪ Increased metabolic rate, GI upset, dry mouth, weight loss Nursing implications: ▪ Drug holidays to diminish addictive tendencies ▪ Addictive potential ▪ VS, cardiac assessment ▪ Individualized scheduling based on pts needs ▪ Careful weaning ▪ Take on an empty stomach Antimigraine Drugs/Serotonin Receptor Agonists Drugs: “-triptan” ▪ Sumatriptan (Imitrex) ▪ Almotriptan (axert) ▪ Rizatriptan (Maxalt) ▪ Eletriptan (Relpax) ▪ Naratriptan (Amerge) ▪ Zolmitriptan (Zomig) ▪ Frovatriptan (Frava) Indications: ▪ Abortive therapy of acute migraine headaches Side effects: ▪ Tingling ▪ Flushing ▪ Congested feeling Nursing implications: ▪ thorough cardiac history ▪ VS (HR, rhythm) Herbal therapy & Supplements Name: ▪ Ginkgo Biloba Use: enhance mental alertness, improve memory Possible interactions: warfarin, asprin ▪ Ginseng Use: enhance impaired mental function and concentration Possible interactions antidiabetics, MAOIs 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 ▪ Dopamine Modulator: causes release of dopamine from storage sites in presynaptic nerve cells ▪ COMT inhibitors: block COMT which blocks breakdown of catecholamines Contraindications: ▪ Drug allergy ▪ Talcapone: liver failure Side effects: ▪ Headache, dizziness, orthostatic hypotension ▪ Nausea, diarrhea ▪ COMT inhibitor: dark, discolored urine. GI upset Evaluation: ▪ Assess postural hypotension ▪ Assess changes in urinary patterns (urinary retention) Nondopamine Dopamine Receptor Agonists Drugs: ▪ Bromocriptine (Parlodel) ▪ Ropinirole (Requip) ▪ Pramipexole (Mirapex) Mechanism of action: ▪ Stimulate presynaptic and/or postsynaptic dopamine receptors to produce more domapine Contraindications ▪ Adrenergic Drugs: anything stimulating SNS (Epi, norepi) Side Effects: ▪ Edema ▪ Insomnia ▪ GI upset, Constipation Evaluation: ▪ Give several hours before bedtime ▪ High protein diet slows absorption: take 30 min prior to eating or 1hr after to avoid altered absorption ▪ Adequate fluid intake Dopamine Replacement Drugs Drugs: ▪ Carbidopa – levodopa (Sinemet) Mechanism of action: ▪ Stimulate presynaptic dopamine receptor to increase brain levels of dopamine Levodopa is the precursor to dopamine Contraindications: ▪ Glaucoma ▪ Undiagnosed skin conditions (can activate malignant melanoma) Side Effects: ▪ Cardiac dysrhythmias, hypotension, dizziness  ▪ Urinary retention, GI distress Evaluation: ▪ Best on empty stomach for protein interactions (Can be taken with food for GI upset) ▪ Takes 2-3 weeks to have a therapeutic effect ▪ Assess postural hypotension ▪ Assess changes in Urinary Patterns (urinary retention, dark urine/sweat) Nursing implications, indications, mechanism of action, and side effects of psychotherapeutic drugs Anxiolytic Drugs: Drugs: ▪ Benzodiazepines: Alprazolam Diazepam Lorazepam ▪ Buspirone (BuSpar) Mechanism of action: ▪ 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 ▪ Dizziness, blurred vision ▪ Headache, nausea Nursing implications: ▪ Labs: CBC, Electrolytes, hepatic/renal function ▪ Orthostatic BP & safety factors ▪ Neuro & mental health assessment Mood-Stabilizing Drugs: Drugs: ▪ Lithium Mechanism of action: ▪ Lithium ions alter sodium transport in nerve cells, which results in a decrease of catecholamines (epi, norepi, dopamine) Indications: ▪ Bipolar disorder (mania) Side effects: ▪ Cardiac dysrhythmia, hypotension, hypothyroidism ▪ Drowsiness, slurred speech ▪ Involuntary movements, ataxia Nursing implications ▪ Monitor Na levels & dietary intake ▪ Monitor Lithium level (0.6-1.2)  ▪ Take 7-14 days to reach therapeutic level ▪ Neuro assessment ▪ VS, BP Antipsychotic drugs Drugs: ▪ Conventional: Chlorpromazine (Thorazine) Prochlorperazine (Compazine) Haloperidol (Haldol) ▪ Atypical: Clozapine (Clozaril) Olanzapine (Zyprexa) Quetiapine (Seroquel) Arpiprazole (Abilify) Risperidone (Risperdal) Mechanism of action: ▪ Block dopamine receptors in the brain in areas associated with s/s of mental illness, emotion, cognitive function, and motor function, which decreases dopamine concentration in CNS and produces tranquilizing effect (Therapeutic & toxic effects from blocking dopamine in CNS) Indications: ▪ Serious mental illnesses: psychoses, schizophrenia, autism, bipolar, adjunctive therapy for depression Side effects: ▪ Agranulocytosis, hemolytic anemia, endocrine symptoms (insulin resistance, weight gain, metabolic syndrome) ▪ Drowsiness, hypotension, weight gain, extrapyramidal symptoms, tardive dyskinesia, neuroleptic malignant syndrome Nursing implications: ▪ Labs: CBC, Seru drug concentration, BUN, LFTs ▪ Neurologic and mental health assessment ▪ Orthostatic BP ▪ Monitor for suicidal ideation ▪ Cardiac assessment Antidepressant drugs: mechanism of action, indications, adverse effects, interactions, and nursing implications Antidepressant Drugs: Drugs: ▪ TCAs: Amitriptyline (Elavil) ▪ MAOIs: “-giline” Rasagiline (Azilect) Selegiline (Eldepryl, Zelapar) ▪ Other: Mirtazapine (Remeron)  Trazodone (Desyrel) Bupropion (Wellbutrin) ▪ SSRIs: Citalopram (Celexa) Fluoxetine (Prozac) Sertraline (Zoloft) Escitalopram (Lexapro) Paroxetine (Paxil) ▪ SNRIS: Duloxetine (Cymbalta) Venlafaxine (Effexor) Desvenlafaxine (Pristiq) Mechanism of action: ▪ TCAs: correct imbalance in serotonin and norepinephrine by blocking presynaptic reuptake, which makes them more available ▪ SSRIs: inhibit reuptake of serotonin ▪ SNRIs: inhibit reuptake of serotonin and norepinephrine Indications: ▪ TCAs: depression, neuropathic pain, insomnia ▪ SSRIs & SNRI: depression, Bipolar OCD, panic attacks Side effects: ▪ TCAs: dry mouth, constipation, urinary retention, sedation ▪ SSRIs & SNRI: insomnia, weight gain, sexual dysfunction, serotonin syndrome (too much serotonin, SNS overstimulated: delirium, agitation, tachycardia, tremors), GI upset Interactions: ▪ TCAs: Anticholinergics, CNS depressants ▪ SSRIs & SNRIs: highly protein bound, warfarin, phenytoin Nursing implications: ▪ TCAs: overdose is lethal ▪ SSRIs: Slowly trapped when Discontinued ▪ Take Weeks to become therapeutic ▪ Monitor suicidal thoughts/ideation ▪ Orthostatic BP ▪ Take with Food & 2-6oz of fluid for GI upset