NUR 240 Pharmacology Final Review 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 Core Patient Variable: Parkinson disease- A progressive neurodegenerative disorder that primarily affects movement control. It occurs due to the loss of dopamine-producing newtons in the brain. Core drug knowledge and Core Patient Variable: 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 - Core drug knowledge and Core Patient Variable: Antifungal medication management Core drug knowledge and Core Patient Variable: Amphotericin B patient teaching 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. Core drug knowledge and Core patient variable: Gentamicin usage caution in certain population 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 - - - Core drug knowledge and Core patient variable: Aminoglycoside medication management - - - - - - - - - - - - - - - Core drug knowledge and Core patient variable: Tylenol antidote ( acetylcysteine) and Tylenol toxicity Core drug knowledge and Core patient variable: Ibuprofen lab monitoring and assessment - Core drug knowledge: Reye's syndrome causing medication - Core drug knowledge and Core patient variable: Acetylsalicylic acid low dose therapeutic effects - - Core drug knowledge and Core patient variable: Antibiotics medication management, patient teaching - - - Core drug knowledge and Core patient variable: Warfarin food and drug interaction, lab monitoring, drug-to-drug interaction, and antidote Antidote for Warfarin is: Vitamin K - - - Core patient variable: Diabetic type I patient teaching - - Antidote for Insulin: Glucagon. Core drug knowledge and Core patient variable: Levothyroxine dosage, lab monitoring and medication therapeutic goal - - - Core drug knowledge and Core patient variable: Hyperthyroid medication management - - - - Core drug knowledge and Core patient variable: Anticoagulation and contraindicated conditions - Core drug knowledge and Core patient variable: Heparin Administration: Subq , IV Antidote : protamine sulfate Monitor: APTT Patient Teaching for Anticoagulant Therapy Purpose and Importance of Therapy Explain the purpose of the anticoagulant (e.g., preventing clots or managing existing conditions like deep vein thrombosis or atrial fibrillation). Emphasize the importance of taking the medication exactly as prescribed to avoid complications. Dosage and Administration Teach the patient the name of the drug, dosage, and timing. For oral anticoagulants like warfarin, take at the same time daily. For injectable anticoagulants like heparin, follow correct administration techniques (e.g., subcutaneous injection sites). Monitoring Stress the need for regular blood tests to monitor clotting times: Warfarin: INR (goal range is usually 2--3, depending on the condition). Heparin: Activated partial thromboplastin time (APTT) or whole blood clotting time (WBCT). Highlight the importance of follow-up appointments to adjust dosages if needed. Bleeding Precautions Recognize signs of bleeding: Unusual bruising, nosebleeds, bleeding gums, or prolonged bleeding from cuts. Dark or tar-like stools, red or pink urine. Headaches, dizziness, or weakness (signs of internal bleeding). Advise using an electric razor instead of a traditional one to prevent cuts. Avoid activities with a high risk of injury (e.g., contact sports). Dietary Considerations If on warfarin, maintain a consistent intake of foods high in vitamin K (e.g., spinach, broccoli) to prevent fluctuating INR levels. Avoid alcohol, as it can increase bleeding risk. Safety Measures Apply pressure to any bleeding site until the bleeding stops. Avoid IM injections unless absolutely necessary. Do not rub subcutaneous injection sites to prevent tissue damage. Drug and Herb Interactions Inform the patient about the risks of drug interactions: Avoid starting or stopping medications without consulting a healthcare provider. Monitor closely if taking aspirin, NSAIDs, or herbal supplements (e.g., ginkgo, garlic, or St. John's Wort) that may increase bleeding risks. Emergency Precautions Educate the patient on the importance of carrying MedicAlert identification indicating they are on anticoagulants. Ensure they understand when to seek immediate medical attention (e.g., severe bleeding, signs of stroke or clot). Antidotes Explain that antidotes are available: Vitamin K or prothrombin complex concentrate for warfarin overdose. Protamine sulfate for heparin overdose. Encouragement and Support Provide reassurance about the safety and effectiveness of the medication when used correctly. Offer emotional support and encourage them to ask questions. Adverse effects : Bleeding, epidural or spinal hematoma, heparin-induced thrombocytopenia, hypersensitivity reactions, loss of hair, bruising, chills, fever, osteoporosis, suppression of renal function (with long-term use). Core drug knowledge and Core patient variable: Anti CoA (HMG CoA) patient teaching, lab monitoring, and adverse effects - - - Dosage calculation: Tablet and Parenteral injections x 3 - - - - - Core drug knowledge and Core patient variable: Beta-Blocker and its medical condition contraindication - - - Core patient variable: Pathophysiological of left side heart failure - - - - - Core patient variable: Pathophysiological of right-side heart failure - - - - BP regulation elements - baroreceptors and stimulates a rise in cardiac output and a generalized vasoconstriction Baroreceptors are like tiny pressure sensors in your blood vessels. They keep track of how much pressure is pushing against the walls of those vessels. When the pressure is high enough, the baroreceptors send a signal to your brain saying, "Everything's fine!" But when the pressure drops, the baroreceptors send a different signal to your brain, like saying, "Hey, the pressure is too low!" Your brain uses this information to help your body adjust and keep things balanced. It's like a teamwork system to make sure your blood is flowing the way it should! When your blood pressure (BP) drops, or your kidneys aren't getting enough blood or oxygen, your body has a backup plan to help fix it. This plan is called the renin-angiotensin-aldosterone system (RAAS). Here's how it works step-by-step: 1\. Kidneys notice the problem: Special cells in your kidneys (juxtaglomerular cells) can sense when BP is low or when they aren't getting enough blood. To fix this, they release a chemical called renin. 2\. Renin starts a reaction: Renin travels in your blood and meets a protein called angiotensinogen (made in your liver). Together, they form angiotensin I. 3\. Angiotensin I gets activated: Angiotensin I travels to your lungs. There, an enzyme called ACE (angiotensin-converting enzyme) changes it into angiotensin II, which is very powerful. 4\. Angiotensin II tightens blood vessels: Angiotensin II makes your blood vessels squeeze tighter (vasoconstriction). This raises your BP and helps push more blood to your kidneys. 5\. Balance restored: Once the blood pressure goes back up, your kidneys stop releasing renin because the problem is fixed. This system helps your body make sure your kidneys keep working properly and your blood pressure stays in a safe range! Low Bp-- sympathetic nervous system gets activated High Bp- Parasympathetic nervous system gets activated. Nitroprusside indication - - - Treats Hypertensive crisis Sustain released medication management and teaching - - - ACE inhibitor adverse effects patient teaching - - Core drug knowledge and Core patient variable: Spironolactone prioritization assessment - - Core drug knowledge and Core patient variable: Loop diuretic usages - - - Core drug knowledge and Core patient variable: Metered dose inhaler proper administration patient teaching - - - - - - - - - Core drug knowledge and Core patient variable: Ranitidine mechanism of action, drug interaction, patient teaching - - - - Core drug knowledge and Core patient variable: Asthma medication management - Core drug knowledge and Core patient variable: Hypothyroid dosing adjustment and lab monitoring. - - Core drug knowledge and Core patient variable: Bowel management program in neurological deficient patients - - - Pt with Core drug knowledge and Core patient variable: Misoprostol patient teaching Core drug knowledge and Core patient variable: Intracranial Pressure medication management - - Acetazolamide: first line drug for ICP Indications Glaucoma: Adjunctive treatment for open-angle glaucoma, secondary glaucoma, and preoperative acute angle-closure glaucoma. Edema: Caused by heart failure or drug-induced. Acute Mountain Sickness: Prevention or treatment of symptoms. Actions Primary Mechanism: Inhibits carbonic anhydrase, leading to: Decreased aqueous humor formation in the eye, lowering intraocular pressure. Reduced hydrogen secretion in renal tubules, leading to diuresis. Pharmacokinetics Route Onset Peak Duration Oral 1 hour 2--4 hours 6--12 hours Sustained-release oral 2 hours 8--12 hours 18--24 hours IV 1--2 minutes 15--18 min 4--5 hours Half-life: 5--6 hours. Excretion: Unchanged in urine. Contraindications and Cautions Avoid Use in: Allergy to acetazolamide or sulfonamides. Chronic noncongestive angle-closure glaucoma. Pregnancy unless benefits outweigh risks. Use with Caution in: Fluid/electrolyte imbalances. Renal or hepatic disease. Respiratory acidosis or COPD. Adverse Effects Electrolyte Imbalances: Metabolic acidosis. Hypokalemia (low potassium). Other Common Effects: Weakness, fatigue, anorexia, nausea. Paresthesia (tingling), confusion, drowsiness. Rash, urinary frequency, renal calculi, tinnitus. Drug--Drug Interactions High-Dose Aspirin: Increases risk of salicylate toxicity. Medications Causing Metabolic Acidosis: Additive effect. Potassium-Lowering Medications: Increased risk of hypokalemia. Other Drugs: May alter excretion, requiring dose adjustments. Clinical Summary Acetazolamide is a versatile diuretic primarily used in glaucoma and mountain sickness. Its effects on hydrogen and bicarbonate excretion help manage specific conditions but require monitoring for metabolic acidosis, hypokalemia, and drug interactions. Core drug knowledge and Core patient variable: Hydrochlorothiazide medication management Core drug knowledge and Core patient variable: Cimetidine adverse effects - - - - - Core drug knowledge and Core patient variable: Clopidogrel and patient health history which contraindicated - - - - - Core drug knowledge and Core patient variable: Corticosteroid mechanism of action in asthma Core drug knowledge and Core patient variable: Antiemetic in post-op patient - Core drug knowledge and Core patient variable: Loop and Potassium sparing diuretic patient teaching Core drug knowledge and Core patient variable: Proton Pump Inhibitors indication Core drug knowledge and Core patient variable: Glucocorticoid/Steroid care planning and medication management - - Core drug knowledge and Core patient variable: Digoxin therapeutic effects Core drug knowledge and Core patient variable: Glipizide patient teaching - - - -