Pharmacy Exam 1 Blueprint PDF

EXAM 1 BLUEPRINT Chapter 7 // // // // // // // // // // // // // // // // // // // // ❖​ Properties and components of cell membrane -​ Some properties are: = Selective Permeability: Controls the movement of substances in and out of the cell. = Fluidity:...

EXAM 1 BLUEPRINT Chapter 7 // // // // // // // // // // // // // // // // // // // // ❖​ Properties and components of cell membrane -​ Some properties are: = Selective Permeability: Controls the movement of substances in and out of the cell. = Fluidity: The membrane components can move laterally, providing flexibility. = Self-Healing: The membrane can repair itself if damaged. = Asymmetry: The two layers of the membrane have different compositions. = Dynamic Nature: Continuously remodels and adapts to environmental changes -​ Components are: = Phospholipid Bilayer = Proteins (Integral Proteins, Peripheral Proteins) = Carbohydrates = Glycoproteins = Glycolipids = Cholesterol​ = Lipids (Sphingolipids, Glycolipids) Chapter 8 // // // // // // // // // // // /// // // // // // // // ❖​ Broad spectrum -​ Interferes with a larger group of infective agents; usually used when inf is still unknown. ❖​ Narrow spectrum -​ Only interferes with specific infective agents ❖​ Bacteriostatic -​ Inhibits the cells reproduction ❖​ Bactericidal -​ Kills the cells completely ❖​ Ways to manage resistance -​ Use antibiotics only when necessary -​ Complete the full course of treatment -​ Use narrow-spectrum antibiotics -​ Proper dosing and timing  -​ Avoid self-medication -​ Monitor for infections and resistance patterns -​ Infection prevention and control -​ Combination therapy -​ Stewardship programs -​ Educate patients and healthcare providers Chapter 9 // // // // // // // // // // // // // // // // // // // // ❖​ Identifying the causative organism -​ Must get a culture!! C&S identifies what is causing the infection so that it can be properly treated ❖​ Macrolides -​ Erythromycin and Azythriomycin -​ Bactericidal; commonly used w/ resp, streptococci, and PID -​ Absorbed GI, crosses placenta+BM(use caution in BF mothers); erythromycin is metabolized in the liver and excreted in feces while azithromycin is excreted through urine. (monitor kidney function) -​ Take on empty stomach; GI upset occurs (n/v/d), anorexia, stomach cramping, C.diff, confusion uncontrolled emotions -​ Increases serum levels of digoxin and effectiveness of anticoagulants, corticosteroids and theophyllines. ❖​ Aminoglycosides -​ Remember GNATS: Gentamicin, Neomycin, Amikicin, Thrombomycin, Streptomycin. -​ Bactericidal, severe infections; pseudomonas, E.coli, staph, etc. -​ Best given IV/IM, 2-3hr ½ life, widely distributed, crosses placenta+BM -​ Watch for ototoxicity and nephrotoxicity! GI upset, CNS, palpitations may also occur -​ Works well w/penicillins and cephalosporins; use caution w/potent diuretics and anesthetics ❖​ Tetracyclines -​ Doxycycline, Minocycline, Demeclocycline, Tetracycline -​ Good for those w/ penicillin allergy; treats wide range of inf, can also be used for acne -​ Absorbed in GI tract; take on empty stomach. Crosses placenta+BM, causes teeth/bone defects,  -​ Causes GI upset, weak teeth and bones, photosensitivity and rash. Avoid in children less than 8 yrs and those w/ known hepatic/renal dysfunction. ❖​ Cephalosporins -​ Cephalexin (Keflex), Cefazollin (Ancef), Cefaclor, Cefdinir, Cefotaxime, Ceftriaxone, Cefepime. -​ Nursing considerations: pts allergic to penicillins have reactions to cephalosporins as well!! Always check med allergies -​ When used in combo w/ aminoglycosides, increased risk for nephrotoxicity; w/ oral anticoagulants, increased risk for bleeding -​ Avoid alcohol for 72 hrs after med is over! ❖​ Fluoroquinolones -​ Remember COLD: Ciprofloxacin, Ofloxacin, Levofloxacin, Delafloxacin -​ Broad spectrum, absorbed GI+metabolized in liver; excreted in urine/feces. Ciprofloxacin is most commonly used; Levo used w/ resp, urine, skin, sinus, anthrax, plague -​ Tendonitis and tendon rupture!! Neuropathy, cartilage lesions, bone marrow depression, h/d, photosensitivity. -​ Monitor QT intervals, increase theophylline and warfarin levels. W/ NSAIDS, may contribute to CNS/seizures. W/ corticosteroids, increases risk of tendon rupture. Chapter 10 // // // // // // // // // // // // // // // // // // // ❖​ HIV/AIDS across Lifespan -​ Children: AIDS drugs are frequently used and adjusted to pediatric doses, or can be used as is as the virus is so harmful. Adjust the dose according to wt, monitor for kidney, bone marrow, and liver effects. -​ Adults: Pts with HIV need to be educated that this will not cure the disease, and take precautions to prevent infections. Pregnant women shouldn't take unless reward over risk and no BF. Use barrier protection if childbearing age. -​ Older adults: More susceptible to adverse effects so monitor closely; if hepatic/renal toxicity already exists then dose should be lowered and adjusted to fit the patients needs. ❖​ Agents for Flu A + Resp viruses  -​ Oseltamivir (Tamiflu), Peramivir, Amantadine, Ribavirin, Nirmatrelvir, Ritonavir (Paxlovid) -​ Affects pt dopamine levels! (dizziness, insomnia, light-headed) ensure their safety. Nausea and skin reactions; SJS. -​ Use caution w/ pregnancy, avoid w/ renal impairment, increases atropine-like effects if admin w/ anticholinergic, reduces effectiveness of acetaminophen and aspirin, avoid live flu vaccine. Chapter 11 // // // // // // // // // // // // // // // // // // // ❖​ Systemic antifungals -​ Assess for hx of any allergies to antifungals, get baseline assessment to monitor for CNS effects and dermatological. Obtain a culture of the area to treat the fungus. Monitor renal+hepatic function ❖​ Topical antifungals -​ Assess for any allergies, establish baseline assessment to see effects. Advise pt to stop the drug if severe rash and or blisters occur. Snsure proper pt teaching! Chapter 53// // // // // // // // // // // // // // // // // // // ❖​ Concept of ventilation -​ Upper respiratory tract: Nose, mouth, pharynx, larynx, trachea -​ Ventilation – process of moving air in and out of body: Controlled by CNS, respiratory center in medulla -​ Lower respiratory tract: Bronchial tree, bronchioles, alveoli -​ Gas exchange/ Respiration: Occurs in alveoli, Transfer of CO2 and O2 ❖​ Atelectasis prevention -​ Deep Breathing Exercises: Practice slow, deep breaths to keep the lungs expanded (use an incentive spirometer if needed). -​ Coughing Techniques: Regular coughing helps clear mucus and prevent blockages. -​ Position Changes: Turn every 2 hours (for bedridden patients) and try postural drainage to help keep airways clear. -​ Early Mobilization: Get out of bed and move as soon as possible to improve lung expansion. -​ Hydration: Stay well-hydrated to help keep mucus thin and easier to clear. Chapter 54 // // // // // // // // // // // // // // // // // // // ❖​ Expectorants  -​ Guaifenesin -​ Available otc, reduces thickness of secretions -​ Caution during pregnancy+persistent cough. DO NOT use for longer than a week! -​ Can cause headaches/dizziness, n/v ❖​ Oral decongestants -​ Pseudoephedrine -​ Available behind the counter-restricted sales (main ingredient can be used to make meth) -​ Shrinks mucous membranes and promotes sinus drainage -​ Use cation in pts w/: glaucoma, hypertension, thyroid disease, coronary artery disease, prostate issues because of the adrenergic properties -​ Adverse effects can be rebound congestion, anxiety/restlessness, tremors, hypertension and arrhythmias -​ DO NOT COMBINE w/ other meds cont. Pseudoephedrine; check your drug labels! ❖​ Antitussives -​ Codeine, Dextromethorphan -​ Acts directly on medullary cough center, depresses cough reflex -​ CONTRAINDICATED in pts needing to cough (post-op), pts w/ asthma and emphysema, DO NOT use during pregnancy/lactation -​ Adverse effects can be increased viscosity of secretions, CNS depression/sedation, drowsiness, constipation, nausea, dry mouth -​ DO NOT COMBINE w/ MAOIs ❖​ OTC Cold/Flu Meds -​ Nursing considerations: do not give otc cold/flu meds to children under 2, always read drug facts and labels to see the active ingredients and avoid accidental overdose. Always consult a healthcare provider before giving meds, use measuring spoons/cups that came with the medicine not household spoons ❖​ OTC Nasal sprays -​ Oxymetazoline (Afrin), Phenylephrine, Tetrahydrozoline -​ Sympathometrics– class of medications that mimic the effects of the sympathetic nervous system -​ Vasoconstriction, reduced swelling of nasal membranes. Not absorbed systemically unless admin. Improperly. -​ CONTRAINDICATED in pts w/ glaucoma, Hypertension, thyroid disease, coronary artery disease, prostate issues because of the adrenergic properties -​ Caution if erosion or lesions in nares– leads to systemic absorption  -​ Adverse effects can occur: local sting/burn, rebound congestion if used longer than 3-5 days, high BP and HR, urinary retention. -​ DO NOT combine w/ other sympathomimetics; serious cardiac effects when used w/cyclopropane or Halothane anesthesia Chapter 55 // // // // // // // // // // // // // // // // // // // ❖​ Xanthines (Bronchodilators/ Anti-asthmatics) -​ Caffeine, Theophylline -​ Directly affects the smooth muscle of resp tract+decreases bronchial swelling -​ CONTRAINDICATIONS: Do not use during pregnancy, caution in pts w/ cardiac disease, alcoholism, hyperthyroidism -​ Adverse effects can be: Effects related to theophylline serum levels 30-35: arrhythmias, hyperglycemia, seizures, death -​ Avoid using these combined, cigarette smoking effects metabolism ❖​ Sympathomimetics -​ Remember TEAL:Terbutaline, Epinephrine, Albuterol,Levalbuterol -​ Dilates bronchi, increased depth/rate of resp; EPI is DOC for acute bronchospasm -​ CONTRAINDICATIONS in pts w/ underlying heart disease, hx or arrhythmias, diabetes, hyperthyroidism. Long acting not recommended for asthmatic pts – black box death warning!! -​ Adverse effects can be tachycardia, hypertension, arrhythmias, sweating, flushing -​ DO NOT USE w/ inhaled anesthetics (severe heart complications) ❖​ Anticholinergics (oral) -​ Ipratropium, Tiotropium -​ Good for pts that cannot tolerate symp. effects, blocks vagal response, leading to bronchodilation. -​ CONTRAINDICATIONS in pts w/ glaucoma, prostate hypertrophy, bladder issues -​ Adverse effects only occur when this med is systemically absorbed; palpitations, headaches, dizziness, urinary retention -​ DO NOT use w/ other anticholinergics ❖​ Leukotriene Receptor (oral) -​ Montelukast -​ Blocks receptors contributing to inflammation/bronchoconstriction -​ NOT USED for emergency use or acute asthma attacks or during pregnancy -​ Adverse effects of h/d/n -​ TOXICITY occurs when combined w/ aspirin Chapter 16 // // // // // // // // // // // // // // // // // // // ❖​ Salicylates -​ ASPIRIN, SALSALATE, OLSALAZINE -​ Anti-inflammatory and anti-pyretic, Inhibits synthesis of prostaglandins and blocks the receptors; Aspirin also inhibits platelet aggregation -​ Used for mild/mod pain, fever, arthritis -​ CONTRAINDICATIONS in pts w/ bleeding abnormalities, renal dysfunction, active chickenpox or influenza, within 1 week of surgery/ invasive procedures, pregnancy/ lactating mothers -​ Some adverse effects are Nausea, dyspepsia bleeding Salicylism –tinnitus, dizziness, n/v/d (reversible); Salicylate toxicity leads to cardiac and respiratory collapse -​ Interacts with many drugs by altering GI absorption, increasing/decreasing therapeutic effects ❖​ NSAIDS -​ IBUPROFEN, NAPROXEN, DICLOFENAC, INDOMETHACIN, KETOROLAC, MELOXICAM, CELECOXIB, ACETAMINOPHEN -​ Strong anti-inflammatory/analgesic effects w/out steroid use; inhibition of prostaglandin synthesis -​ Start w/ ibuprofen for rheumatoid arthritis!!! -​ CONTRAINDICATIONS are, do not use in pregnancy, CV dysfunction, GI bleeds, caution in pts w/ renal dysfunction -​ Adverse effects consist of nausea, dyspepsia, GI pain, HA, dizziness, fatigue, rash, mouth sores -​ Interactions that occur are; decreased effect of diuretics and beta blockers, lithium toxicity when combined w/ ibuprofen ❖​ Anti-Arthritis -​ AURANOFIN (GOLD COMPOUND) -​ Gold compound uses gold salts (chrysotherapy) to utilize macrophages – inhibits phagocytosis -​ Good to use for patients with rheumatoid arthritis when traditional NSAIDs are no longer effective -​ Teratogenic; use barrier protection -​ TOXIC in pts w/ severe diabetes, CHF, severe debilitation, or renal/liver dysfunction -​ Adverse effects include stomatitis, pharyngitis, colitis, diarrhea -​ DO NOT combine w/ anti-malarials or immunosuppressants ❖​ Acetaminophen -​ Acts directly on Thermoregulatory cells in hypothalamus to cause sweating and vasodilation -​ Vary harsh on the liver!!  -​ Check other OTC meds for ingredients containing acetaminophen; taking too much would result in liver toxicity and even overdose!! Chapter 18 // // // // // // // // // // // // // // // // // // // ❖​ Vaccine nursing considerations -​ Patient Assessment: Review allergies, immunization history, and age/health status. -​ Vaccine Administration: Ensure correct route (IM/SC) and site, proper storage, and timely administration. Document vaccines administered accurately. -​ Monitor for Reactions: Watch for adverse reactions immediately post-vaccine (15-30 mins), Common reactions: pain, swelling, fever, Report serious adverse events to VAERS. -​ Patient Education: Explain the vaccine schedule, potential side effects, and when to seek medical help for severe reactions. ❖​ Vaccine teaching points -​ Vaccine Purpose: Prevent disease, protect vulnerable populations (herd immunity). -​ Side Effects: Mild side effects (pain, fever) are common; advise on rest, hydration, and OTC pain relief. -​ Vaccination Schedule: Emphasize importance of completing full vaccine series and boosters. -​ Address Concerns: Provide factual information to counter myths (e.g., vaccines do not cause autism). -​ Special Populations: Tailor education for pregnant or immunocompromised patients. Advise on travel-related vaccines. -​ Access & Cost: Inform about insurance coverage, free/low-cost clinics, and programs like Vaccines for Children (VFC). REMEMBER THE CAUTIONS W/ VACCINES Chapter 14 // // // // // // // // // // // // // // // // // // // ❖​ Extravasation -​ Refers to the leakage of fluid, such as blood, lymph, or other substances, from a blood vessel or tube into the surrounding tissues -​ Trauma: Injury or puncture to a blood vessel. -​ Infection: Inflammatory processes that damage the vessel walls. -​ Cancer: Cancer cells can spread and block lymphatic vessels, leading to extravasation. -​ Medication: Certain medications, such as chemotherapy drugs, can cause irritation and damage to blood vessels. -​ Intravenous (IV) procedures: Improper placement or dislodgement of an IV catheter can result in extravasation  -​ Symptoms of extravasation may include redness, swelling, pain, and a bluish discoloration of the affected area. In severe cases, it can lead to tissue damage, necrosis (cell death), and infection. ❖​ Antimetabolites -​ Methotrexate -​ These are drugs that interfere with the normal metabolism of cells by mimicking essential metabolites (building blocks) and preventing their use -​ Assess for hx of: allergies to these meds, bone marrow suppression, renal/hepatic function, current pregnancy/lactation, and GI diseases -​ Get baseline assessment to monitor for CNS effects, resp effects, and cardiac effects -​ Monitor lab results and tests to see any critical changes -​ Across the lifespan: -​ Pediatric Population: Uses: Common for cancers like leukemia and autoimmune conditions. Pharmacokinetics: Children metabolize drugs differently, requiring adjusted dosing. Side Effects: May experience more intense side effects (e.g., bone marrow suppression, liver toxicity).Considerations: Monitoring for growth and developmental impacts is crucial. -​ Adult Population: Uses: Frequently used for cancer treatment and autoimmune diseases.Pharmacokinetics: Adults typically metabolize antimetabolites more efficiently, though adjustments are needed for conditions like liver or kidney disease.Side Effects: Bone marrow suppression and organ toxicity (especially liver) are common.Considerations: Monitoring for these side effects is critical, especially in individuals with comorbid conditions. -​ Geriatric Population: Uses: Used for cancer and autoimmune diseases more common in aging individuals. Pharmacokinetics: Reduced organ function means slower drug metabolism, requiring dose adjustments. Side Effects: Older adults are more vulnerable to toxicity (e.g., myelosuppression, organ damage). Considerations: Watch for polypharmacy issues and cognitive decline affecting treatment adherence. -​ General Concerns Across All Ages: Teratogenicity: Antimetabolites can harm fetal development, so pregnancy precautions are necessary.Bone Marrow Suppression: A common and serious side effect, requiring regular blood tests. Organ Function: Kidney and liver health are critical in determining drug doses and preventing toxicity. Long-Term Effects: Chronic use can lead to liver or kidney damage, necessitating ongoing monitoring.  ❖​ Hormones and Hormone modulators -​ Tamoxifen -​ Assess for hx of: allergies to these meds, bone marrow suppression, renal/hepatic function, current pregnancy/lactation, and GI diseases -​ Monitor tumor responsiveness with assessments -​ Get baseline assessment to monitor for CNS effects, resp effects, and cardiac effects Chapter 17 // // // // // // // // // // // // // // // // // // // ❖​ Colony stimulating factors -​ Nursing Considerations: Administer via subcutaneous or intravenous route. Monitor for bone pain, which can be managed with analgesics. Monitor for leukocytosis (elevated WBC count). Be alert for rare but serious splenic rupture, presenting as left upper abdominal or shoulder pain. Monitor for signs of infection (fever, chills) as CSFs do not prevent infection. -​ Teaching Needs: Emphasize infection prevention through hand hygiene and avoiding crowds. Teach about potential bone pain and how to manage it with pain relievers. Instruct on the importance of regular blood tests to monitor WBC levels. Educate on reporting any signs of infection promptly. ❖​ Immune suppressants -​ Nursing Considerations: Monitor for signs of infection due to impaired immune function. Regularly assess liver and renal function, as well as CBC for signs of toxicity (e.g., hepatotoxicity, nephrotoxicity, myelosuppression). Watch for drug interactions that may increase toxicity or interfere with efficacy. Monitor for signs of organ damage (e.g., liver or kidney dysfunction) -​ Teaching Needs: Stress the importance of adherence to prescribed regimen and routine blood work. Educate on infection precautions (good hygiene, avoiding sick individuals). Teach patients to report signs of toxicity (fever, nausea, unusual bruising). Advise avoiding alcohol for drugs like methotrexate. ❖​ T and B cell suppressors -​ Nursing Considerations: Monitor for signs of organ rejection, especially in transplant patients. Monitor renal function closely (serum creatinine, BUN). Regularly assess blood pressure as these drugs can cause hypertension. Monitor potassium levels for risk of hyperkalemia. Be mindful of drug interactions, especially with antifungals, antibiotics, etc. -​ Teaching Needs: Educate on signs of organ rejection (fever, transplant site pain) and when to seek medical attention. Reinforce the importance of adherence to medication regimen. Instruct on regular kidney function tests, blood pressure monitoring, and avoiding grapefruit. Teach about avoiding live vaccines while on immunosuppressive therapy. Reinforce infection prevention strategies due to increased susceptibility. -​