NUR 240 Pharmacology Final Review 3 PDF

**0NUR 240: Pharmacology for Nursing Practice** **Final Blueprint Fall 2024** The Exam details: The Exam consists of 60 questions. You have 1 ½ minute per question.. **The Exam Blueprint** Core drug knowledge and Core patient variable: Opioids side effects, assessment, patient teaching including...

**0NUR 240: Pharmacology for Nursing Practice** **Final Blueprint Fall 2024** The Exam details: The Exam consists of 60 questions. You have 1 ½ minute per question.. **The Exam Blueprint** Core drug knowledge and Core patient variable: Opioids side effects, assessment, patient teaching including the opioids antidote **Pharmacokinetics -- what's on your drug template** **Patient variable**: age weight race medical hx genetics diet are examples Opioids: side effects: respiratory depression, CNS depression. Headache, constipation, (increase fluids) bradycardia, drowsiness -- use narcan to help when someone is on an opioid Scheduled 1,2,3 -- Schedule 1 higher use and addiction/abuse Pt teaching- increase fiber and avoid alcohol Assessment- assess respiratory and cardiac before administering meds. Antidote: Naloxone Core drug knowledge: Levodopa-Carbidopa mechanism of action - Levodopa-Carbidopa Action: Parkinsonis is characterized by a deficiency in dopamine, a precursor of levodopa. Adverse effects:. tremor, dizziness, numbness, weakness, agitation, anxiety, anorexia, nausea, vomiting, dry mouth dysphagia, urinary retention, flushing, cardiac irregularities, psychosis Contraindication:. Interaction:. Traditional (1st-generation) antipsychotics and preparations with vitamin B6 MAOI antidepressants within 2 weeks can cause hypertensive crisis High-protein meals Anticholinergic medications Cystic Fibrosis: Cystic fibrosis (CF) is a hereditary disease involving the epithelial lining of the respiratory, gastrointestinal, and reproductive tracts. There is a defective gene on chromosome 7 that make the epithelial membrane more impermeable to chloride CF results in the accumulation of copious amounts of thick secretions in the lungs Low calorie diet high proteins diet , chest physical therapy Parkinson disease- A progressive neurodegenerative disorder that primarily affects movement control. It occurs due to the loss of dopamine-producing newtons in the brain. Parkinson's disease Parkinson's Disease (PD): Definition: Parkinson's disease is a progressive neurodegenerative disorder that primarily affects movement control. It occurs due to the loss of dopamine-producing neurons in the brain, particularly in the substantia nigra, which is responsible for controlling muscle coordination and movement. Key Characteristics: Main Features: Lack of Coordination: Difficulty with voluntary movements, leading to impaired coordination. Rhythmic Tremors: Often starting gradually and most noticeable at rest, these tremors are a hallmark of the disease. Rigidity: Muscle stiffness, which may affect certain muscle groups, limiting movement. Bradykinesia: Extreme slowness in initiating and executing movements, which makes daily tasks more difficult. Motor Symptoms: Shuffling Gait: A distinctive walking pattern with short steps and difficulty lifting the feet off the ground. Drooling: Due to difficulty swallowing and reduced facial muscle movement. Slow, Slurred Speech: Often resulting from muscle rigidity in the face and mouth. Masklike Expression: A reduced range of facial expressions, caused by the inability to control facial muscles. Progression of Disease: Difficulty Swallowing: This can lead to choking and aspiration pneumonia as the disease advances. Cognitive Changes: Early stages often preserve cognitive function, but about 20% of patients may develop severe cognitive impairment and dementia affecting: Visuospatial Discrimination: Difficulty judging distances or interpreting visual information. Memory Retrieval: Problems recalling information. Frontal Lobe Executive Functioning: Difficulty planning, organizing, and carrying out tasks. Parkinsonism: Definition: A general term used to describe Parkinson's disease-like symptoms (e.g., tremors, rigidity, bradykinesia) caused by factors other than Parkinson's disease. Causes of Parkinsonism: Dopamine-Blocking Medications Brain Tumors Severe Carbon Monoxide Poisoning Cerebrovascular Disease Brain Injuries Summary: Parkinson's disease is a chronic condition caused by the a decrease in dopamine-producing neurons, leading to motor control issues and cognitive decline. Parkinsonism, on the other hand, refers to symptoms resembling Parkinson's disease but caused by other external factors, such as medication or brain injury. What is most common clinical manifestation in parkinson disease ? Tremors Chlorpromazine adverse effects- Dry mouth, constipation, blurred vision, tachycardia, photosensitivity. **Chlorpromazine (Antipsychotics)** **Action:** Contraindication: Bone marrow suppression Pregnancy/lactating Interaction: CNS depressants Antacids and antidiarrheals PRECAUTIONS: Adverse drug effect:( **chlorpromazine)** Core drug knowledge and Core patient variable: Antipsychotic care goal, prioritization - Core drug knowledge and Core patient variable: Lithium therapeutic level; and lithium lab monitoring with diuretic medication combination therapy - - - - - - Text Reference The adverse effects associated with lithium are often directly related to serum levels of the drug. There is risk of weight gain, renal toxicity, and goiter and hypothyroidism with long-term use. Serum levels of less than 1.5 mEq/L: CNS problems, including lethargy, slurred speech, muscle weakness, and fine tremor; polyuria, which relates to renal toxicity; and beginning of gastric toxicity, with nausea, vomiting, and diarrhea Serum levels of 1.5 to 2 mEq/L: Intensification of all of the foregoing reactions, with ECG changes demonstrating bradycardia and sometimes Brugada's syndrome Serum levels of 2 to 2.5 mEq/L: Possible progression of CNS effects to ataxia, clonic movements, hyperreflexia, and seizures; possible CV effects such as severe ECG changes and hypotension; large output of dilute urine secondary to renal toxicity; fatalities secondary to pulmonary toxicity Serum levels greater than 2.5 mEq/L: Complex multiorgan toxicity with a significant risk of death Core drug knowledge and Core patient variable: MAOIs food and drug interaction - Core drug knowledge: Benzodiazepine antidote - - Core drug knowledge and Core Patient Variable: Antiseizure medication management in pregnancy - **amphotericin B (**Abelcet, AmBisome) The action involves binding to the sterols in the fungus cell wall, thereby altering the permeability of the cell wall. This change can lead to cell death (fungicidal effect) or prevent the fungal cells from reproducing (fungistatic effect ) Amphotericin B is available in IV form in two formulations that have reduced adverse effects and in the original deoxycholate formulation *[Adverse Effects of Antifungal Drugs]* General Adverse Effects Liver and Kidney Toxicity: Close monitoring of liver and kidney function is necessary due to potential toxic effects. Bone Marrow Suppression: Reported with the use of antifungal drugs. Dermatological Changes: Includes rash and other skin-related effects. Drug-Specific Adverse Effects 1\. Amphotericin B Renal impairment: associated with severe kidney damage. Bone Marrow Suppression: requires close monitoring. Gastrointestinal (GI) Effects: Includes nausea, vomiting, severe diarrhea, anorexia, and weight loss. Injection site reactions can include pain, phlebitis, or thrombophlebitis. *[Contraindications and Cautions for Antifungal Medications]* Amphotericin B Formulations: Available in several forms; dosages vary, so careful differentiation is required. Pregnancy: Can be used successfully during pregnancy, but with caution. Lactation: Crosses into human milk; not recommended due to potential risks to the neonate. Clinically Important Drug--Drug Interactions **Amphotericin B** **Clinically Important Drug--Drug Interactions** Risk of Severe Renal Toxicity: Patients taking amphotericin B should avoid concurrent use of the following nephrotoxic drugs unless absolutely necessary: 1\. Nephrotoxic Antibiotics 2\. Antineoplastic Drugs (used in cancer treatment) 3\. Cyclosporine Patient Teaching for Systemic Antifungals Purpose of Medication This medication is used to treat fungal infections in your body. Completing the entire course of treatment is important to get the full benefit, even if symptoms improve before the medication is finished. How to Take the Medication Take the medication exactly as prescribed. If taking the medication by mouth, take it with food to help reduce stomach upset. Do not stop the medication early, even if you feel better. Some infections may require treatment for several months. Possible Side Effects and How to Manage Them Gastrointestinal (GI) Upset: You may experience nausea, vomiting, or diarrhea. Try eating small, frequent meals to manage this. Central Nervous System (CNS) Effects: Dizziness or weakness may occur. Avoid driving or operating heavy machinery if you feel dizzy, and change positions slowly to prevent falls. Skin Changes: If you notice a rash or other skin issues, let your healthcare provider know. Infusion Reactions (for IV medications): Fever, chills, or headache may occur. If these symptoms are severe, notify your healthcare provider immediately. What to Watch For Serious Symptoms to Report: Contact your healthcare provider right away if you experience: A sore throat or unusual bruising or bleeding (which could indicate a blood problem). Yellowing of your skin or eyes (a sign of liver problems). Severe nausea or vomiting that interferes with eating or hydration. Additional Tips for Safety Stay hydrated and maintain a healthy diet to support your recovery. If taking IV medication, report any redness, swelling, or pain at the infusion site. Keep all follow-up appointments to monitor your liver, kidneys, and bloodwork. When to Call the Healthcare Provider If your symptoms do not improve or worsen. If you experience severe side effects or have questions about your medication. Core drug knowledge and Core patient variable: Rifampin patient teaching Urine, tears , and sweat has a red- orange color, which is harmless. ( side effect) Take meds as prescribed, even if you start feeling better. Rifampin treats TB and other bacterial infections. Gentamicin usage caution in certain population Always monitor intake & output Potent antibiotic very strong Narrow therapeutic window Broad spectrum antibiotic - - - Peak : Drug Efficacy 30--90 min Trough : Serum levels - Gentamicin Indications: Treatment of serious infections caused by susceptible bacteria. Actions: Inhibits protein synthesis in susceptible strains of gram-negative bacteria, disrupting functional integrity of the cell membrane and causing cell death. Pharmacokinetics: Adverse Effects: Hypersensitivity, sinusitis, dizziness, rash, fever, risk of nephrotoxicity, and ototoxicity Pt teaching - - - - - - Lactulose - - - Aminoglycoside medication management - - - - - - - - - - - - - - **Glomerular Filtration Rate** Normal range 120-130 mL per minute with GFR 90 ml or more within normal limits Mild disease → GFR 60-89 mL per minute Moderate disease - GFR 30-59 mL per minute Severe disease → GFR 15- 29 mL per minute Renal disease → GFR \