exam 3 study guide.pdf

The University of Alabama Capstone College of Nursing NUR 521 Advanced Pharmacology Exam 3 Blueprint and Study Guide...

The University of Alabama Capstone College of Nursing NUR 521 Advanced Pharmacology Exam 3 Blueprint and Study Guide Fall 2023 General Tips for Exam Success: A review of anatomy and pathophysiology is included at the beginning of most modules in the course. You will not see many direct questions about this information; however, this foundational knowledge is necessary to understand how drugs work in the body and how the body responds to drugs. You will be much more successful if you have a strong foundational knowledge and understanding of this information. You are responsible for knowing the name, MOA, Use, Common AE, Serious AE, Dosing, Administration, CI, Interactions, and Patient Education for all prototype drugs included in each module. Most of the exam questions will focus on the prototype drugs presented in each module. You also need to know about the drug class across the life span. There is content in each module that discusses use of each drug class in pediatric, pregnancy, breastfeeding, and older adult populations. You won’t necessarily need to know an exact dose for prescribing on all of the prototype drugs, but if faculty stresses a certain dose in a lecture, you will be responsible for this information. When attempting to narrow down the content, consider what you need to know to be a safe prescriber. Also, listen for tips and what is emphasized in the lecture. This study guide is intended to help you focus your studies, but it does not include a list of all necessary details about each individual drug. If any evidenced base guidelines were presented in the module, I would be sure to review what information was discussed by faculty in the lecture. Module Qs Topic Module 7: 15 Review all prototype drugs presented in the module. Know how they work and what they are used for (see above for what you Anti- are responsible for knowing). What was stressed in lecture? What are safety considerations (contraindications, precautions, inflammatory etc.)? , Antiallergic, Anti-inflammatory Immunologic, How is a Tylenol overdose treated? Acetylcysteine is the specific antidote for acetaminophen overdose. It is 100% effective when and Cancer given within 8 to 10 hours after ingestion and may still have some benefit after this interval. What patient education would you provide to patients on Aspirin (especially if it is long-term use)? Irreversible Inhibition of cyclooxygenase (the enzyme responsible for making prostaglandins); suppresses inflammation, pain relief, fever reducer, and protects against MI & stroke – 1st gen NSAID; AE: GI bleed Tylenol? Cr, LFTs, liver damage with 3+ alcohol drinks/day Ibuprofen? 1st gen NSAID; can increase risk of fatal heart attack or stroke (BBW); DO NOT use before or after cardiac bypass surgery (CABG), GI bleed Prednisone? DO NOT take with fungal infection, DO NOT stop abruptly (can weaken immune system so notify HCP of S/S infection), take with food, may lead to bone loss so take with Vit D & Ca. Monitor: Glucose, electrolytes, BP, weight, CXR, eye exam if tx >6 weeks. AE: adrenal insufficiency, cushing syndrome, DM, infection, GI perforation, tendon rupture, weight gain, hirsutism, emotional lability, rash, muscle atrophy, skin pigmentation changes Know the recommendations for anti-inflammatory medication use in pregnancy and while breastfeeding.  ASA- only low dose; NOT safe in 3rd trimester/30weeks (can cause anemia, postpartum hemorrhage, premature closing of the ductus arteriosus)  Tylenol – safe  Ibuprofen – weight risk/benefit before 30 weeks, do not give after. NSAID of choice while breastfeeding  Celecoxib/Naproxen – same as ibuprofen, may use while breastfeeding What labs should be monitored when prescribing anti-inflammatory medications?  Cr baseline, BP, CBC, BMP, coagulation tests; avoid use if CrCl 1yr o Phenytoin use can decrease levels o AE: neuropsychiatric events, HA, URI, mood changes o Given as adjunct to glucocorticoids to prevent inflammation daily basis (granules)  Long acting muscarinic antagonist (LAMA) – Tiotropium (Spiriva) o Same as SAA below but lasts for 24 hrs instead of 6 and better scheduling o Monitor for anticholinergic effects: constipation, retention, tachy, blurred vision o AE: HA, cough, nasopharyngitis  Short acting anticholinergic (SAA) – ipratropium (Atrovent) o MOA: blocks muscarinic receptors in the bronchi, reducing bronchoconstriction o Pt ed: sugarless hard candy to help with dry mouth o USE: COPD maintenance and mod-severe asthma exacerbation  Short acting B2 agonists (SABA) – Albuterol (proair) – prn  Long acting B2 agonists (LABA) – Salmeterol (Serevent diskus) – preferred in COPD and must be combined with glucocorticoid in asthma  o Both long & short (SABAs & LABAs) activate B2 receptors which = bronchodilation to reduce bronchospasm o AE: tremor, tachy, angina o Pt ed: using spacer with one way valve may improve results  Methylxanthine – theophylline o Bronchodilation but only used when other drugs are too expensive  How is COPD and asthma diagnosed? o COPD: Spirometry values are not considered in the initiation of therapy though play a role in the diagnosis and severity assessment of COPD. In addition to considerations of history and signs and symptoms of COPD, diagnosis of COPD requires spirometry testing. Patients who have signs and symptoms of COPD should be tested to measure the degree of airway obstruction. A postbronchodilator forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) of less than 0.7 is needed to confirm the COPD diagnosis. o Lung function tests – spirometry o In asthma may also check eosinophils and IgE (if high = asthma)  What are the classic characteristics of COPD and asthma? What differentiates them and what similarities do they have? Asthma Similarities COPD  Breathlessness  Wheezing  Airway restriction  Chest tightening  Dyspnea  Inflammation  Cough  Chronic cough  Drug therapy helpful  Excessive sputum production  Cause: binding of allergens (not  Poor exercise tolerance preventable)  Drug therapy not very helpful  Cause preventable (smoking)  Know the initial treatment recommendations for COPD and asthma o Inhaled glucocorticoids are first-line therapy for management of the inflammatory component of asthma. There is conflicting evidence to support routine glucocorticoid use in COPD. Their primary use in COPD is in management of exacerbations. o SABA PRN FOR INT ASTHMA (STEP 1), STEP 2 – ICS (most effective for long term control therapy)  What medication would you prescribe if a patient falls into Group A, Group B, etc. for the management of COPD? o 0-1 mod exacerbations not requiring hospitalization  Group A: bronchodilator  Group B: LABA + LAMA o 2+ mod exacerbation with 1 leading to hospitalization  Group A: LABA + LAMA (preferred to short acting agents)  Group B: LABA + LAMA + ICS if eosinophil count >300   ICS = inhaled corticosteroids  How is asthma classified and how does that affect the medication management? STEPS AND AGE  Discuss the affects of ICS to growth in children – may slow growth in children but so does poorly controlled asthma  What medications should not be used as monotherapy in COPD and asthma? o ICS monotherapy is not recommended in the management of COPD. o In asthma, LABAs should no be used as monotherapy for long term use or to treat acute symptoms.  What medications affect theophylline levels? o Interacts with caffeine by decreasing theophylline breakdown o Tobacco and marijuana increase theophylline clearance o Phenobarbital, phenytoin and rifampin lower theophylline levels o Cimetidine and fluroquinolone antibiotics (such as ciprofloxacin) elevate theophylline levels  What factors affect the pathogenesis of PUD? How is PUD treated? And prevented? o Peptic ulcers develop when there is an imbalance between mucosal defensive factors and aggressive factors. o The major defensive factors are mucus and bicarbonate. The major aggressive factors are H. pylori, nonsteroidal antinflammatory drugs (NSAIDs), gastric acid, and pepsin, smoking o Tx: abx, PPIs, H2 antagonists, mucosal protectants (carafate), others (antacids) o Bismuth quadruple: PPI + bismuth subcitrate + tetracycline + flagyl/metrodinazole o Levo triple: levo + amoxicillin + PPI o Concomitant: PPI + Clarithromycin + Amoxicillin + nitroimidazole o If PCN allergy: clarithromycin triple + metronidazole + bismuth quadruple  What vitamin levels should be monitored when prescribing antiulcer medications? o B12, Mg, Ca  Know the indications and contraindications for PPIs. o Indications: Adults: GERD, Duodenal and gastric ulcer treatment and prevention, Hypersecretory conditions like Zollinger-Ellison, H. Pylori, Pediatric: GERD and H. Pylori o CI: Use with caution in poor CYP2C19 metabolizes; hepatic impairment; hypocalcemia risk; hypomagnesemia risk; fracture risk; C. difficile risk; Pneumonia risk  Explain the difference between laxative effect and catharsis. o Laxative is mild slow formed vs. catharsis fast watery total evac of colon; colonoscopy  Discuss the considerations for prescribing gastrointestinal medications in infants, children, pregnant women, breastfeeding women and alder adults. o Caution in pregnancy (can induce labor) o Senna is safe in kids and breastfeeding o Older adults careful of dehydration (they’re obsessed with their poop habits)  What medication would you prescribe to prevent constipation in a patient who is bed bound and why? Colace  Know the contraindications and what to monitor for when prescribing bowel cleansing products in preparation for a  colonoscopy. o (1) sodium phosphate; visicol & osmoprep  Can cause kidney damage but better patient acceptance ecause the PEG-ELS products require ingestion of a large volume of liquid, whereas the sodium phosphate products do not. Nonetheless, sodium phosphate products should be avoided by patients at risk, including those with electrolyte abnormalities, renal impairment, and hypovolemia. o (2) a combination of sodium picosulfate, magnesium oxide, and citric acid; (PREPOPIK)  the sodium phosphate and combination products are hypertonic and can cause dehydration and electrolyte disturbances. o (3) PEG plus electrolytes (ELS) – GoLytely - The PEG-ELS products are isotonic with body fluids and hence do not alter water or electrolyte status.  What prescription medication is most commonly used to prevent motion sickness and what would you teach your patient about the use of this medication? o Scopolamine – muscarinic antagonist, AE: dry mouth, blurred vision, drowsiness (most effective/ patch is better) Module 9: 20  Classification of bacteria – shape, staining of cell wall, aerobic (needs O2) vs. anaerobic (does not need O2) Antimicrobial o Cocci (circles) and STDs o Diplococci o Bacilli (rod-shaped) o Streptococci (circles in a chain) o Spirochetes (Spiral shaped) o Cell walls: made up of different percentages of peptidoglycan, an amino acid and sugar complex.  Gram-positive – thick cell wall; purple stain  Gram-negative – thin wall; pink stain o Named: Genus species i.e., N. gonorrhoeae, meaning it belongs to the genus Neisseria and the species gonorrhoeae  Classification of antimicrobial drugs o Narrow-spectrum antibiotics, are active against only a few species of microorganisms. o Broad-spectrum antibiotics are active against a wide variety of microbes. Narrow-spectrum drugs are generally preferred to broad-spectrum drugs because this is specified treatment for that bug and might minimize resistance. o Can also be classified by their MOA  Drug resistance o Review ABX and Microbial causes of drug resistance  Microbial Ecology: if a drug-resistant organism is present, antibiotics will create selection pressure favoring its growth by killing off sensitive organisms.  All antimicrobial drugs promote drug-resistant organisms, but broad-spectrum agents do the most to  facilitate resistance.  Acquired resistance can be from DNA mutations changes in microbial genome  Selection of antimicrobial drugs. o How do you choose one drug over another to treat microbial infections? There are several factors to consider including drug spectrum, use, patient presentation, type of infection. You might be presented with some scenarios and must make a choice.  Start with broad-spectrum if needed in urgent and emergent situations.  Obtain culture before starting drug.  Identify the organism and then make adjustments on drug selection.  Microscopic examination of gram-stained preparation  PCR testing is also available (new for c dif, s aureus, tb, n gonorhea, chlamydia, h pylori)  Prophylactic use of antimicrobial drugs o Surgery o Bacterial Endocarditis o Neutropenia o Recurrent UTI  Monitoring therapy – resolution of infection Review all prototype drugs presented in the module. Know how they work and what they are used for. Know what bacteria they treat. Use your antibiotic chart learning activity to organize and learn this information. What was stressed in lecture? What are safety considerations (contraindications, etc). What would you teach your patient about each of the prototype drugs.  Amoxicillin (Moxatag) – penicillin (broad spectrum, aminopenicillin ½) o Gram - & + use for: Pharyngitis, group A strep, tonsillitis, otitis media, H. pylori, Lower respiratory infections, rhinosinusitis, Skin, UTI, Prevention of endocarditis prophylaxis with dental procedures o AE: allopurinol or mono can increase risk of rash  Cephalosporin - Cephelaxin (Keflex) (alt if allergy to PCN) o Bactericidal, broad, similar to PCNs, one of the safest, low toxicity o 1st gen – gram +, staph or strep, surgical prophylaxis, narrow spectrum (bone, resp, UTI, skin) o CI if severe allergy to PCN o AE: rash, diarrhea, c dif (rare)  Carbapenem – imipenem & cilastatin (primaxin) o Broad; gram + & -; good for mixed infections such as s. aureus & gram – bacilli, blood stream, bone, joint, GYN, ABD, PNA, skin, UTI o CI use with Valproate (seizures)  o IV dose only o AE: superinfection  Glycopeptide/other - Vancomycin (Vancocin) o Use: gram + bacteria ONLY, tx for c dif or MRSA, S. aureus, Staphylococcus epidermis (MRSA), streptococci, penicillin-resistant pneumococci, C. difficile, Alternative to PCN and cephalosporins to treat severe infections (e.g., staphylococcal and streptococcal endocarditis) in patients allergic to β-lactam antibiotics. o CI: Renal impairment, increased nephrotoxicity with aminoglycosides o IV mostly (poor GI absorption), PO for c dif o AE: redman Bacteriostatic  Tetracyclines – 2nd line agents – 7 forms (doxycycline) o CI: kids