ANRS201 Pharmacology ATI-Style Exam Three Combined Study Guide

Comprehensive set of 250 flashcards covering gastrointestinal, analgesic, anti-inflammatory, neuromuscular, antiseizure, antimicrobial, antidepressant, and anxiolytic medications for ATI Pharmacology Exam Three review.

Gastroesophageal Reflux Disease (GERD)

A condition where the lower esophageal sphincter relaxes or is weak, allowing stomach acid to move into the esophagus, potentially causing heartburn, regurgitation, esophagitis, and aspiration risk.

Peptic Ulcer Disease (PUD)

Damage to the stomach or duodenal mucosal lining, commonly associated with Helicobacter pylori infection or NSAID use, with complications including bleeding and perforation.

Chemoreceptor Trigger Zone (CTZ)

An area in the brain that, along with the vomiting center, is stimulated to produce nausea and vomiting; prolonged vomiting can lead to dehydration, hypokalemia, and metabolic alkalosis.

Constipation

Slow intestinal transit or hard stool, often related to low fiber/fluid intake, immobility, or medications such as opioids, anticholinergics, or iron.

Diarrhea Complications

Increased intestinal secretion or decreased absorption carrying clinical risks of dehydration, electrolyte loss, and skin breakdown.

Inflammatory Bowel Disease (IBD)

Chronic intestinal inflammatory conditions, including Crohn disease and ulcerative colitis, that can produce pain, diarrhea, bleeding, and malnutrition.

Crohn Disease

A form of inflammatory bowel disease that can affect any GI segment from mouth to anus and is characterized by transmural inflammation.

Ulcerative Colitis

A form of inflammatory bowel disease that affects the colon and rectum with continuous mucosal inflammation.

Antacids

Medications that neutralize existing stomach acid to provide rapid, short-term symptom relief for occasional heartburn and indigestion without treating the underlying cause of an ulcer.

Calcium Carbonate

An antacid that neutralizes gastric acid; side effects include constipation, and excess intake can cause hypercalcemia and kidney stones.

Magnesium Hydroxide

An antacid and osmotic agent that neutralizes gastric acid; commonly causes diarrhea and carries a risk of magnesium accumulation in renal impairment.

Aluminum Hydroxide

An antacid that neutralizes stomach acid; commonly causes constipation and carries a risk of aluminum accumulation in clients with kidney impairment.

Two-Hour Antacid Spacing Rule

The nursing guideline requiring antacids to be separated from many other oral medications by about $2\,\text{hours}$ because antacids can impair drug absorption.

Histamine H2-Receptor Blockers

Drugs that block histamine H2 receptors on gastric parietal cells, thereby reducing gastric acid secretion in GERD, heartburn, and peptic ulcer disease.

Famotidine

An H2-receptor blocker used for GERD and peptic ulcers; may require dose reduction in renal impairment and can cause headache, dizziness, or confusion in older adults.

Cimetidine

An H2-receptor blocker known for numerous drug interactions and potential endocrine adverse effects, including gynecomastia and sexual dysfunction.

Proton Pump Inhibitors (PPIs)

Medications that irreversibly inhibit the gastric $H^+/K^+$ ATPase proton pump, strongly reducing acid production for GERD, esophagitis, ulcers, and H. pylori therapy.

Omeprazole

A prototype proton pump inhibitor taken before meals to suppress gastric acid production; delayed-release formulations must be swallowed whole.

Pantoprazole

A proton pump inhibitor used to suppress gastric acid secretion in GERD, erosive esophagitis, and stress-ulcer prevention in high-risk clients.

Esomeprazole

A proton pump inhibitor that strongly suppresses gastric acid secretion by irreversibly inhibiting the gastric $H^+/K^+$ ATPase enzyme.

Clostridioides difficile Diarrhea (PPI Risk)

A serious adverse effect associated with long-term proton pump inhibitor therapy, presenting as persistent watery diarrhea that should not be independently self-treated with antidiarrheals.

Hypomagnesemia (PPI Risk)

A potential electrolyte complication of prolonged proton pump inhibitor therapy that requires monitoring for symptoms such as muscle cramps.

PPI Bone Fracture Risk

A recognized complication linked to long-term proton pump inhibitor use, warranting administration of the lowest effective dose for the appropriate duration.

PPI Administration Protocol

The instruction to administer proton pump inhibitors before meals, swallow delayed-release forms intact, and instruct clients never to discontinue prescribed courses independently.

Sucralfate

A mucosal protectant that forms a protective chemical barrier over ulcerated tissue in duodenal ulcers without significantly suppressing stomach acid.

Sucralfate Dosing Protocol

Administration guideline requiring sucralfate to be taken on an empty stomach $1\,\text{hour}$ before meals and at bedtime, separated from other medications by at least $2\,\text{hours}$.

Misoprostol

A synthetic prostaglandin analog that decreases gastric acid and increases protective mucus and bicarbonate to prevent NSAID-induced gastric ulcers.

Misoprostol Pregnancy Contraindication

Absolute contraindication during pregnancy when used for ulcer prevention because it stimulates uterine contractions, causing uterine bleeding and pregnancy loss.

Ondansetron

A serotonin 5-HT3 receptor antagonist that prevents nausea and vomiting; common side effects include headache and constipation.

Ondansetron QT Prolongation Risk

A serious cardiac adverse effect of ondansetron exacerbated by electrolyte abnormalities like hypokalemia or hypomagnesemia and concurrent QT-prolonging drugs.

Metoclopramide

A dopamine receptor antagonist and upper GI prokinetic agent used for selected nausea and gastroparesis; contraindicated in GI obstruction, perforation, or hemorrhage.

Extrapyramidal Symptoms (EPS)

Movement disorders that can occur with dopamine antagonists such as metoclopramide, including restlessness, dystonic movements, and rigidity.

Tardive Dyskinesia

A potentially irreversible neurologic complication associated with prolonged metoclopramide use, characterized by involuntary, repetitive movements such as lip smacking and tongue protrusion.

Promethazine

A phenothiazine antihistamine with antiemetic and sedating actions; can cause marked drowsiness, anticholinergic effects, and severe respiratory depression.

Scopolamine

An anticholinergic transdermal medication used to prevent motion sickness; adverse effects include dry mouth, blurred vision, urinary retention, and confusion.

Aprepitant

A substance P / neurokinin-1 (NK1) receptor antagonist used for chemotherapy-induced nausea; interacts with CYP3A4 drugs and reduces hormonal contraceptive efficacy.

Bulk-Forming Laxatives

Laxative agents like psyllium that absorb water, increasing stool mass and stretching the intestinal wall to stimulate mechanical peristalsis.

Psyllium

A bulk-forming laxative that must be taken with a full glass of water; contraindicated in the presence of GI obstruction or swallowing difficulties.

Osmotic Laxatives

Poorly absorbed compounds such as polyethylene glycol, lactulose, and magnesium hydroxide that draw water into the intestinal lumen via osmotic gradient.

Polyethylene Glycol

An osmotic laxative that retains water in the stool to soften it and increase stool frequency; requires monitoring of hydration and electrolytes.

Lactulose

An osmotic laxative used to treat constipation and promote fecal excretion of ammonia in clients with hepatic encephalopathy.

Stool Softeners

Surfactant laxatives such as docusate that facilitate the penetration of water and lipids into fecal mass to prevent straining.

Docusate

A stool softener useful for preventing straining after surgery or myocardial infarction; not intended as an effective treatment for severe acute constipation.

Stimulant Laxatives

Laxatives such as senna and bisacodyl that directly stimulate intestinal sensory nerve endings to accelerate colonic transit and fluid secretion.

Bisacodyl

A stimulant laxative that increases peristalsis; can cause abdominal cramping, diarrhea, and electrolyte imbalance, and should not be used routinely long term.

Laxative Pre-Administration Assessment

The clinical requirement to assess bowel sounds, pain, distention, last bowel movement, and rule out obstruction; laxatives are withheld for rigid abdomen or absent sounds.

Loperamide

An antidiarrheal agent that slows intestinal peristalsis; contraindicated in clients presenting with bloody diarrhea, high fever, or suspected invasive enteritis/C. difficile.

Bismuth Subsalicylate

An antidiarrheal and mucosal protective agent that coats the GI lining; can cause harmless black tongue and dark stools, and is avoided in children with viral illness.

Mesalamine

A 5-aminosalicylate anti-inflammatory drug used to induce and maintain remission in ulcerative colitis; requires monitoring of baseline and ongoing renal function.

Sulfasalazine

An anti-inflammatory agent for inflammatory bowel disease; causes photosensitivity, GI upset, and folate deficiency, requiring CBC and liver function monitoring.

Acute Pain

A protective physiologic response to tissue injury with a well-defined onset and expected healing timeline.

Chronic Pain

Persistent pain extending beyond the normal healing timeframe that adversely impacts physical functioning, mobility, sleep, and emotional health.

NSAIDs (Nonsteroidal Anti-inflammatory Drugs)

A class of analgesics that inhibit cyclooxygenase enzymes, thereby decreasing prostaglandin synthesis to reduce pain, fever, and peripheral inflammation.

Cyclooxygenase-1 (COX-1)

An enzyme isoform that produces prostaglandins supporting gastric mucosal protection, renal blood flow regulation, and platelet aggregation.

Cyclooxygenase-2 (COX-2)

An inducible enzyme isoform primarily synthesized at sites of tissue damage and inflammation that mediates pain and inflammatory responses.

Ibuprofen

A nonselective NSAID used for mild-to-moderate pain and inflammation; carries risks of dyspepsia, fluid retention, gastric ulceration, and renal impairment.

Naproxen

A nonselective NSAID prescribed for inflammatory disorders and pain; requires monitoring for gastrointestinal bleeding, hypertension, and renal toxicity.

Ketorolac Five-Day Limit

A clinical safety mandate restricting total systemic ketorolac use to a maximum of $5\,\text{days}$ due to severe risks of peptic ulceration, GI hemorrhage, and renal failure.

Celecoxib (Celebrex)

A selective COX-2 inhibitor that reduces pain and inflammation with lower GI irritation risk but retains cardiovascular thrombotic and renal risks.

Celecoxib Peri-CABG Contraindication

A boxed contraindication prohibiting celecoxib for the treatment of perioperative pain in clients undergoing coronary artery bypass graft surgery.

NSAID Gestational Restrictions

The directive to avoid NSAIDs starting at $20\,\text{weeks}$ of pregnancy and especially at $30\,\text{weeks}$ and beyond due to risks of oligohydramnios and premature closure of the fetal ductus arteriosus.

Aspirin

A salicylate that irreversibly inhibits platelet COX-1, suppressing thromboxane A2 production and platelet aggregation for the lifespan of the platelet.

Aspirin Antiplatelet Mechanism

Irreversible acetylation of platelet cyclooxygenase-1, preventing the synthesis of thromboxane A2 and thereby suppressing platelet clotting activity.

Reye Syndrome

A rare, life-threatening condition involving encephalopathy and fatty liver failure triggered by giving aspirin or salicylates to children or teenagers recovering from viral infections.

Salicylism

A syndrome of aspirin toxicity characterized by tinnitus, hyperventilation, diaphoresis, nausea, vomiting, and acid-base disturbances.

Acetaminophen (Tylenol)

A centrally acting analgesic and antipyretic with minimal peripheral anti-inflammatory activity, often chosen when NSAIDs are contraindicated.

Acetaminophen Hepatotoxicity

Dose-dependent liver injury resulting from toxic accumulation of NAPQI, especially during acute overdose, concurrent alcohol abuse, or pre-existing liver disease.

Acetylcysteine

The specific antidote administered to prevent or mitigate hepatic necrosis following an overdose of acetaminophen.

Opioid Analgesics

Agonists at central nervous system opioid receptors, particularly mu receptors, that modulate pain perception and transmission for moderate-to-severe pain.

Mu Opioid Receptors

Primary CNS receptors stimulated by opioid medications to achieve analgesia, but which also mediate respiratory depression, sedation, euphoria, and constipation.

Morphine

A prototype strong opioid analgesic used for moderate-to-severe acute and chronic pain; monitored for sedation, bradypnea, constipation, and hypotension.

Hydrocodone

An opioid analgesic frequently combined with acetaminophen for moderate pain management, requiring assessment of total daily APAP and respiratory depression risks.

Hydromorphone

A potent mu-opioid receptor agonist used for severe pain; requires careful dose verification because it is significantly more potent than morphine milligram-for-milligram.

Fentanyl

A high-potency synthetic opioid agonist indicated for severe acute or chronic pain in opioid-tolerant patients; carries a severe risk of fatal respiratory depression.

Oxycodone

An oral opioid analgesic available in immediate-release and extended-release forms; extended-release tablets must never be crushed, chewed, or dissolved.

Codeine

A weaker opioid analgesic used for mild-to-moderate pain and antitussive therapy; prodrug requiring metabolic conversion to morphine in the liver.

Tramadol

A centrally acting synthetic analgesic that binds mu-opioid receptors and inhibits reuptake of serotonin and norepinephrine, carrying risks of seizures and serotonin syndrome.

Opioid-Induced Respiratory Depression

The most hazardous adverse effect of opioid therapy, resulting from direct blunting of the brainstem respiratory center; progressive sedation typically precedes respiratory arrest.

Naloxone

A pure opioid antagonist that rapidly reverses opioid-induced respiratory depression and central nervous system sedation by displacing opioids from receptor sites.

Naloxone Recurrent Depression Risk

The clinical danger that naloxone has a shorter half-life than many opioids, which can allow severe respiratory depression to recur after naloxone wears off.

Opioid Overdose Triad

The classic clinical presentation of severe opioid toxicity consisting of decreased level of consciousness, respiratory depression, and pinpoint (miotic) pupils.

Opioid Withdrawal Syndrome

A constellation of symptoms upon abrupt cessation of opioids, including rhinorrhea, lacrimation, yawning, piloerection, diaphoresis, dilated pupils, abdominal cramping, and tachycardia.

Gabapentin

A neuromodulator that binds alpha-2-delta calcium-channel subunits to suppress excitatory neurotransmitter release; indicated for neuropathic pain and focal seizures.

Pregabalin

An adjuvant analgesic that modulates alpha-2-delta calcium channels to treat neuropathic pain, fibromyalgia, and seizures; monitored for dizziness, somnolence, and peripheral edema.

Topical Lidocaine

A local anesthetic patch or cream that blocks voltage-gated sodium channels in cutaneous sensory nerves; apply only to intact skin and avoid external heat sources.

Topical Capsaicin

A topical agent that depletes peripheral substance P with regular application; produces initial burning, requires handwashing, and must be kept away from the eyes.

Substance P

A neurotransmitter stored in peripheral sensory nociceptive fibers that transmits pain signals to the central nervous system; targeted by topical capsaicin.

Corticosteroids (Glucocorticoids)

Hormones that bind intracellular glucocorticoid receptors to suppress inflammatory gene expression, leukocyte migration, and cytokine production.

Prednisone

An oral glucocorticoid used for inflammatory and autoimmune flares; side effects include hyperglycemia, insomnia, fluid retention, osteoporosis, and infection risk.

Dexamethasone

A potent, long-acting synthetic glucocorticoid with minimal mineralocorticoid activity, used for severe inflammation, cerebral edema, and antiemetic protocols.

Corticosteroid Tapering

The essential practice of gradually reducing corticosteroid doses after prolonged therapy to prevent acute adrenal crisis by allowing the HPA axis time to recover endogenous hormone production.

Adrenal Suppression

Exogenous glucocorticoid feedback inhibition of the hypothalamic-pituitary-adrenal axis that leaves the body unable to synthesize cortisol during acute physiological stress.

DMARDs (Disease-Modifying Antirheumatic Drugs)

Immunomodulatory medications like methotrexate and hydroxychloroquine that slow or halt the progression of autoimmune joint damage rather than solely treating pain.

Methotrexate

A nonbiologic DMARD and folate antagonist used for rheumatoid arthritis; adverse effects include bone marrow suppression, hepatotoxicity, and stomatitis.

Methotrexate Weekly Regimen

The explicit dosing protocol for methotrexate in autoimmune diseases (administered once weekly, not daily); daily dosing can cause fatal bone marrow toxicity and overdose.

Hydroxychloroquine

A disease-modifying antirheumatic drug used in systemic lupus erythematosus and rheumatoid arthritis; requires regular ophthalmologic examinations to screen for retinal toxicity.

Azathioprine

An immunosuppressive prodrug that inhibits purine synthesis, suppressing lymphocyte proliferation; requires routine monitoring of CBC and liver function tests.

Allopurinol

A xanthine oxidase inhibitor used for chronic gout maintenance by preventing uric acid formation; ineffective for acute gout attack pain relief.

Allopurinol Hypersensitivity Syndrome

A severe, potentially fatal drug reaction characterized by rash, fever, eosinophilia, hepatitis, and acute renal failure, requiring immediate cessation at the first sign of rash.

Febuxostat (Uloric)

A xanthine oxidase inhibitor for chronic urate-lowering in gout; carries a boxed warning regarding an increased risk of cardiovascular death compared to allopurinol.