Pharmacology Exam 1 Study Guide PDF

PHARMACOLOGY EXAM 1 STUDY GUIDE (Ch. 4, 52, 18, 19, 20, 21) Ch 52 Antiemetic and Antinausea Drugs Antiemetics are drugs given to relieve nausea and vomiting. “emesis” = vomiting 7 categories of antiemetic drugs, all have different mechanisms of action but mostly work the same by blocking pathway...

PHARMACOLOGY EXAM 1 STUDY GUIDE (Ch. 4, 52, 18, 19, 20, 21) Ch 52 Antiemetic and Antinausea Drugs Antiemetics are drugs given to relieve nausea and vomiting. “emesis” = vomiting 7 categories of antiemetic drugs, all have different mechanisms of action but mostly work the same by blocking pathways that induce vomiting. Chemoreceptors Trigger Zone (CTZ): area of the brain that is involved in the sensation of nausea and the action of vomiting. Metoclopramide (Reglan) Class: Prokinetic Drug Route: PO , Parenteral, prescription only​ Indications: GERD, delayed gastric emptying, N/V Mechanism of Action: Blocks dopamine receptors in the CTZ, causes CTZ to be desensitized to impulses it receives from GI tract, stimulates peristalsis in GI tract, enhancing emptying of the stomach contents Contraindications: patients with ​ Seizure disorders ​ Pheochromocytoma ‘tumor developed in adrenal glands’ ​ breast cancer ​ GI obstruction ​ Allergic to it or procaine, procainamide Adverse Effects: ​ Long term use cause irreversible tardive dyskinesia ​ Extrapyramidal effects ‘movement disorders’ = tremors, muscle contractions, eye spasms, lip smacking, tongue protrusion Nursing Implications: ​ Assess medical history ​ Assess current Medications ​ Assess for contradictions and potential drug interactions Patient Education: ​ Cause severe drowsiness ​ Warn patients about driving or performing any hazardous tasks Extra Notes: ​ Only available by prescription because can cause severe adverse effects if used incorrectly Ondansetron (Zofran) Classification: Serotonin Blocker Route: PO , injectable form 8mg IV push over 2min Indications: ​ Nausea / vomiting in patients receiving chemotherapy ​ Postoperative ​ Hyperemesis gravidarum (N/V pregnancy) 4 Mechanism of Action: block serotonin receptors in the GI tract, CTZ, and VC Contraindications: ​ Cat B medication concern regarding development of cleft palate when used during first trimester Adverse Effects: known drug allergy Nursing Implications: ​ Assess complete nausea/vomiting history including precipitation factors ​ Assess current medications  ​ For chemo patients, antiemetics are given 30-60 min before chemo begins Patient Education: ​ Many cause drowsiness, warn patients not to drive or do hazerdous stuff ​ If taken with alcohol can cause severe centeral nervous system depression ​ Change positions slowly to avoid hypotensive effects Meclizine (Antivert) Classification: Antihistamine (H1 receptor blockers) Route: PO Indications: ​ Motion sickness ​ Non-productive cough ​ Allergy symptoms ​ Sedation ​ Vertigo Mechanism of Action: inhibit ACH by binding to H1 receptors, prevent cholinergic stimulation in vestibular and reticular area, thus preventing nausea and vomiting Contraindication: ​ Shock ​ Lactation Adverse Effects: ​ Drowsy ​ Fast heartbeat ​ Hives, itchy, rash ​ Headaches Nursing Implications: assess drug allergy, drug interactions Patient Education: cause drowsiness caution doing things need to be awake 💢HIGH ALERT Promethazine (Phenergan, Phenadoz, Promethegan) Classification: Antidopaminergic Route: PO, IM ‘preferred’, IV ‘common but not preferred’ Indications: ​ Psychotic disorders ​ Intractable hiccups ​ relieve/prevent symptoms of hay fever ​ Allergic conjunctivitis Mechanism of Action: block dopamine receptors in the CTV Contraindications: children less than 2 years bc risk of fatal respiratory depression Adverse Effects: ​ Sedation most common and my be beneficial ‘ ​ Drowsiness ​ Dry mouth ​ Lightheaded Nursing Implications: ​ Dilute in at least 10ml of fluid ‘the more dilute the better’ ​ Given in a running IV line at the port farthest from the patients vein or through a large borne vein (not hand or wrist) ​ Discontinue immediatly if burning or pain occurs while administering Patient Education: ​ Impair thinking / reactions ​ Avoid alcohol ​ Avoid opiods such as codeine, morphone, oxycodone 💢Notes: ​ NEVER give intra arterial route can cause severe tissue damage, often requiring amputation Scopolamine (Transderm-Scop, Scopace) Classification: Anticholinergic [ACh] blocker Route:72-hr transdermal patch releases 1mg Indications: ​ Most common treatment for N/V associated w/motion sickness ​ Postoperative N/V ​ Reduce secretion before surgery Mechanism of Action: ​ Binds to and blocks ACh receptors in the inner ear labyrinth, ​ Blocks transmission of nauseating stimuli to CTZ, and stimuli from the reticular formation to VC Contraindications: patients with ​ Glaucoma ​ Pyloric obstruction ​ Urinary bladder neck obstruction Adverse Effects: ​ dizziness ​ Blurred vision ​ Confusion ​ Hallucinations ​ Urinary retention Nursing implications: ​ Carefully assess for history of glaucoma, scopolamine can worsen this condition by causing pupillary dilation and increased intraocular pressure ​ Monitor for signs of confusion, especially in older patients. Patient Education: ​ Avoid activities such as driving, operating heavy machinery Ch. Adrenergic Agonists (Sympathomimetics) ANS and SNS play a big role in adrenergics. Catecholamines: Endogenous ‘have receptors’ Alpha 1 and 2 Receptors ​ Epinephrine ​ Norepinephrine ​ Dopamine Alpha 1: located on post synaptic cell “effector cell” Alpha 2: located on pre synaptic ↑Vasoconstriction= agonist action , Vasodilation = antagonist action Beta 1 receptors: located on arterials causing vasoconstriction, primary located in heart “cardioselective drugs” Beta 2 receptors: located in lungs and arterials Dopaminergic: dilates blood vessels causing increased blood flow ​ Renal , Mesenteric, Coronary, Cerebral Adrenergic Meds: Stimulate SNS mimicking the response of a neurotransmitters. Indications: ​ CV: heart failure, shock ​ Resp: bronchodilation, nasal congestion ​ GU: overactive bladder BPH  ​ Eyes: open angle glaucoma Contraindications: Hypertension Interactions: ​ TCA ​ Herbs, OTC drugs ​ MAOIs ​ Mixing w/adrenergic antagonist Adverse Effects: ​ Palpations leading to dysrhythmias Toxicity: ​ Seizures and stroke due to extreme BP Treatments: ​ *Symptoms management ​ Antidote : sympatholytic medications, most common: Clonidine 💢HIGH ALERT Epinephrine (Epi-Pen) 1-10mg/ml NASCAR: nervousness, angina, sugar increase(glycogenolysis),cardiac arrest, allergy, respiratory distress Classification: Alpha and Beta adrenergic agonist Indications: ​ Anaphylaxis ​ Bronchospasm ​ Cardiac arrest ​ Asthma Mechanism of Action: ​ Binds to alpha receptors causing vasoconstriction Contraindications: ​ *hypertension ​ Hypersensitivity ​ CAD ​ Tachyarrhythmias Adverse Effects: ​ *palpitations ​ Tachy ​ Anxiety ​ Tremors ​ Hypertension ​ Headache Nursing Implications: ​ Monitor vitals ​ Cardiac rhythm 💢HIGH ALERT Dopamine (Inotropen) DRAG: dilation pupil, rate heart ^, arterioles BP^, gi drag motility Classification: Beta 1 Adrenergic Agonist Route: IV 1-50 mcg/kg/min Indications: diff doses = diff things ​ Low dose dilate blood vessels in the brain, heart, kidneys and mesentery increasing blood flow to those areas ​ Higher improve cardiac contractility and output ​ Highest for vasoconstriction Mechanism of Action:  ​ Acts through SNS ​ Produces positive chronotropic and inotropic effects on myocardium Contraindications: ​ In pts who have catecholamine - secreting tumor of the adrenal gland known as pheochromocytoma Adverse Effects: ​ Dilated pupils ​ Increased HR/BP ​ GI tract motility ​ Chest pain ​ Headache Nursing Implications: monitor ​ BP, HR, ECG, urine input and output, signs of ischemia Mirabegron (Myrbetriq) Classification: GU Adrenergic Agonist (Beta 3 adrenergic) Route: PO 20-50mg/day Indications: treatment if overactive bladder Mechanism of Action: ​ relaxes detrusor muscle leading to increased bladder capacity ​ Targets receptors in urothelium and detrusor muscles Contraindications: None reported Adverse Effects: HTN, UTI, HA, nausea, nasopharyngitis, dizziness Nursing Implications: assess ​ Renal , Hepatic, Cardiac function before treatment Patient Education: take as prescribed, do not stop abruptly Ch. 19 Adrenergic Blocking Drugs Tamsulosin (Flomax) Classification: Alpha Adrenergic Blocker Route: PO 0.4-0.8mg/day for BPH Indications: ​ Indicated for males with BPH ​ Females w/ kidney stones or urinary retention Mechanism of Action: ​ Block alpha - adrenergic receptors on smooth muscle within the prostate and bladder ​ Relaxes smooth muscle fibers and improves urinary flow Contraindications: ​ Current use of ED medications such as sildenafil (Viagra) Adverse Effects: HA, abnormal ejaculation, rhinitis, abdominal pain Nursing Implications: monitor ​ Dizziness, orthostatic hypotension ​ Urinary retention Patient Education: ​ Report dizziness ​ Counsel on potential retrograde ejaculation Sotalol (Betapace) Classification: Nonselective Beta Blocker Route: PO 80mg Indications: used for management of difficult to treat dysrhythmias Mechanism of Action: Class III antiarrhythmic properties  ​ Blocks potassium channels, prolonging the action potential duration and refractory period of cardiac muscle ​ Suppresses abnormal rhythms Contraindications: ​ Bronchial asthma ​ Sinus bradycardia ​ Cardiogenic Shock Adverse Effects: ​ Torsades de pointes ​ Fatigue, dizziness ​ Bronchospasm ​ Heart failure Nursing Implications: ​ Check for rebound HTN ​ Monitor after giving Patient Education: ​ Report irregular heartbeats ​ Avoid abrupt discontinuation Metoprolol (Lopressor) Classification: Beta 1 Blocker Route: IV💢, PO, succinate 50mg form Indications: ​ Treats HBP, Angina, heart failure Mechanism of Action: acts on beta 1 receptors in the heart and reduces the effects of catecholamines on cardiac function Contraindications: pt w/ ​ metabolic acidosis ​ Lung disease ​ Asthma ​ Hypotension Adverse Effects: skin rash, diarrhea, dyspnea Nursing Implications: ​ *monitor BP ​ Check pulses frequently Ch. 20 Cholinergic Drugs Memantine (Namenda) Classification: N-methyl-D-aspartate (NMDA) receptor antagonist Route: PO 5mg/day Indications: NOT a cholinergic drug but is included because used in treatment of Alzheimer's dementia. Mechanism of Action: ​ stimulation of those receptors is thought to be part of the dementia process ​ Memantine blocks the stimulation and thereby helps reduce or arrest degeneration of the patient's cognitive symptoms. Contraindications: known drug allergy Adverse Effects: uncommon but my include ​ Confusion ​ Hypotension ​ Headache ​ GI upset  ​ Musculoskeletal pain ​ Dyspnea ​ Ataxia ​ Fatigue Nursing Implications: ​ Check for GI mechanical obstruction Patient Education: ​ Take with food to avoid GI upset Pyridostigmine (Mestinon) Classification: Indirect-Acting Cholinergic Drugs Route: PO 600 mg/day in 2 dose, IV 0.1-0.25mg/kg/dose Indications: ​ Improves muscle strength ​ Used to relieve the symptoms of myasthenia gravis ‘most common drug for that ​ Reverses the effects of nondepolarizing neuromuscular drugs after surgery Mechanism of Action: ​ Increases acetylcholine by inhibiting acetylcholinesterase Contraindications: ​ Mechanical obstruction of the GI or GU tracts ​ Asthma ​ Gangrene ​ Hyperthyroidism’ ​ Cardiovascular disease Adverse Effects: ​ GI upset / excessive salivation Nursing Implications: ​ If for postoperative related check for gi obstruction or if suspected dont give Ch. 21 Anticholinergic Drugs AKA Cholinergic-Blocking Drugs Oxybutynin (Ditropan) Classification: Synthetic Antimuscarinic Drug Route: PO 5-30 mg/day , Transdermal Patch avail. OTC Indications: ​ Treatment of overactive bladder (OAB) ​ Also used as a antispasmodic for neurogenic bladder associated with spinal cord injuries and congenital conditions such as spina bifida Mechanism of Action: anticholinergic medication that blocks the muscarinic action of acetylcholine on smooth muscle cells in the bladder. This inhibits involuntary bladder contractions and increases bladder capacity. Contraindications: ​ Allergy ​ Urinary or gastric retention ​ Uncontrolled angle-closure glaucoma Adverse Effects: ​ Dry mouth ​ Constipation ​ blurred vision ​ Drowsiness ​ Dizziness ​ tachycardia ​ urinary retention Nursing Implications: Monitor for anticholinergic side effects, especially in elderly patients. Ensure adequate fluid intake. Assess for urinary retention. Provide reassurance that dry mouth is an expected side effect Patient Education: Take with food or milk to minimize dry mouth. Stay well-hydrated. Report difficulty urinating, severe constipation or vision changes. Avoid tasks requiring mental alertness until medication's effects are known. Discuss alternatives if side effects are intolerable. Dicyclomine (Bentyl) Classification: Synthetic Antispasmodic Cholinergic Blocker Route: PO 80-160 mg/day Indications: ​ Treatment of irritable bowel syndrome ​ Treatment of functional disturbances of GI tract Mechanism of Action: Dicyclomine is an anticholinergic agent that blocks the muscarinic action of acetylcholine on smooth muscle cells in the gastrointestinal tract. This inhibits smooth muscle contractions and intestinal spasms. Contraindications: ​ Pts w/ angle - closure glaucoma ​ GI tract obstructions ​ Myasthenia Gravis ​ Paralytic ileus ​ GI atony ​ Toxic Megacolon Adverse Effects: Dry mouth, blurred vision, constipation, urinary retention, drowsiness, dizziness, tachycardia. Nursing Implications: Monitor for anticholinergic side effects, especially in elderly patients. Ensure adequate fluid intake and use stool softeners to prevent constipation. Assess for urinary retention. Provide reassurance that dry mouth is an expected effect. Patient Education: Take with food or milk to minimize dry mouth. Stay well-hydrated. Report difficulty urinating, severe constipation or vision changes. Avoid driving or operating machinery until medication effects are known. Discuss alternatives if side effects persist. Ch. 4 Cultural and Ethical Considerations Veracity - The principle of truthfulness and honesty in communication and actions. Nonmaleficence - The principle of avoiding harm or injury to others. Nurses have an obligation to protect patients from harm. Autonomy -The right of patients to make decisions about their medical care without coercion. Nurses respect patient autonomy. Beneficence - The principle of doing good and promoting wellbeing for the patient. Nurses act in the best interest of patients. Confidentiality - Protecting patient information and privacy. Nurses maintain confidentiality of patient records and health details. Justice - Fairness and equal treatment. Nurses provide care without discrimination based on personal attributes or circumstances. These principles are essential in determining nursing negligence and liability in legal cases involving patient harm. ↓ Duty: Nurses have a legal and ethical duty to provide competent care that meets the standard of care. Breach of Duty: Occurs when a nurse fails to uphold their duty, deviating from the standard of care expected. Causation: Establishes a direct link between the nurse's breach of duty and the harm caused to the patient. Damage: Refers to the actual injury or harm suffered by the patient as a result of the nurse's breach of duty. A cultural assessment is a systematic process of gathering data about a patient's cultural background, beliefs, values, and practices that may influence their health behaviors and care preferences. It involves asking open-ended questions to explore areas such as: - Cultural identity and heritage - Language and communication patterns - Family roles and organization - Dietary practices and food preferences - Use of traditional remedies or healers herbs - Beliefs about health, illness, and the body - Attitudes towards pain and suffering - Spiritual and religious practices - Views on death and dying