Unit 2 Exam Study Guide: Pharmacology and Nursing Care

A comprehensive vocabulary review of perioperative medications, analgesics, neurological agents, psychiatric medications, substance use disorders, and respiratory rescue drugs based on the Unit 2 exam study material.

IV Opioid Analgesics Administration

A nursing procedure requiring assessment of respiratory rate, $O_2$ saturation, blood pressure, sedation level, and pain score prior to delivery; doses are held if the respiratory rate is under $12\,\text{breaths/min}$, diluted per manufacturer instructions, pushed slowly over $1\text{--}5\,\text{minutes}$, and kept with naloxone immediately available at the bedside.

Opioid Withdrawal

A syndrome peaking at $1\text{--}3\,\text{days}$ and lasting $5\text{--}7\,\text{days}$ after opioid cessation, characterized by dilated pupils, gooseflesh, sweating, rhinorrhea, lacrimation, yawning, vomiting, diarrhea, insomnia, hypertension, tachycardia, and cravings; managed with clonidine, a methadone taper, buprenorphine, or lofexidine.

Naloxone (Narcan)

An opioid antagonist administered intravenously, intramuscularly, or intranasally and repeated every $2\text{--}3\,\text{minutes}$ as needed to reverse narcotic overdose signs (pinpoint pupils, slow breathing, unresponsiveness); requires ongoing monitoring because its duration of action may be shorter than the opioid.

Tolerance

An expected physiological adaptation to chronic opioid therapy in which an increased amount of drug is required over time to produce the same therapeutic effect, which does not constitute addiction.

Physical Dependence

An expected physiological state produced by chronic opioid therapy that results in withdrawal signs and symptoms if the medication is stopped abruptly, distinct from compulsive psychological addiction.

Pseudoaddiction

A pattern of drug-seeking behavior exhibited by a patient because their pain is undertreated, which resolves once effective pain control is achieved.

Patient-Controlled Analgesia (PCA) Pump

An intravenous delivery system with a programmed lockout to prevent overdose, which must strictly and solely be activated by the patient before pain becomes severe or before physical activity.

Codeine Sulfate

An oral opioid analgesic whose most common adverse effect is constipation; it is contraindicated in pediatric patients under $12\,\text{years}$ of age and requires restricting total acetaminophen intake below $3\text{--}4\,\text{g/day}$ when prescribed as combination Tylenol #3.

Methadone

A synthetic opioid with a prolonged half-life that accumulates in tissue, creating delayed respiratory depression risks; requires monitoring of respiratory rate (notifying the provider if under $10\,\text{breaths/min}$), sedation, intake and output for urinary retention, and electrocardiograms for $\text{QT}$ prolongation and torsades de pointes.

Transdermal Fentanyl

A transdermal analgesic patch reserved exclusively for opioid-tolerant clients with chronic or cancer pain, featuring an onset of $12\text{--}24\,\text{hours}$, a peak effect at $48\text{--}72\,\text{hours}$, and application changes every $72\,\text{hours}$; it must never be cut or exposed to external heat sources.

Spinal Analgesia Adverse Effects

Complications secondary to neuraxial blockade, including hypotension and bradycardia from sympathetic denervation, respiratory depression from epidural opioids, urinary retention, lower-extremity numbness requiring fall precautions, and spinal headache managed by keeping the patient flat and administering fluids and caffeine.

Local Anesthetic Systemic Toxicity (LAST)

A life-threatening systemic complication occurring in an ordered progression: perioral numbness, metallic taste, tinnitus, and agitation, leading to seizures, coma, respiratory arrest, dysrhythmias, and cardiovascular collapse; treated by terminating the injection, administering $100\%$ oxygen, controlling seizures, and infusing $20\%$ lipid emulsion.

Malignant Hyperthermia

An inherited pharmacogenetic reaction triggered by volatile inhaled anesthetics (isoflurane, desflurane, sevoflurane) or succinylcholine, manifesting as masseter muscle rigidity, rapid hypercapnia, tachycardia, extreme pyrexia, metabolic acidosis, and hyperkalemia; managed by stopping the agent, hyperventilating with $100\%$ oxygen, cooling, and infusing intravenous dantrolene.

Scopolamine

An anticholinergic transdermal patch applied to the postauricular area $4\,\text{hours}$ before travel to prevent motion sickness for $3\,\text{days}$; it requires immediate handwashing after handling to avoid pupil dilation, and is contraindicated in narrow-angle glaucoma and benign prostatic hyperplasia.

Carbidopa-Levodopa (Sinemet)

A dopamine replacement combination for Parkinson's disease where levodopa crosses the blood-brain barrier to form dopamine and carbidopa inhibits peripheral breakdown; major adverse effects include orthostatic hypotension, dyskinesias, palpitations, hallucinations, and dark urine or perspiration.

Benztropine

A centrally acting anticholinergic medication used to treat extrapyramidal symptoms and parkinsonism that causes dry mouth, blurred vision, urinary retention, constipation, tachycardia, memory impairment, and anhidrosis with overheating risk; contraindicated in glaucoma.

Phenytoin (Dilantin)

An antiepileptic agent with a therapeutic range of $10\text{--}20\,\mu\text{g/mL}$ ($7.5\text{--}20\,\mu\text{g/mL}$ per drug guide) that requires monitoring of gingival hyperplasia, Stevens-Johnson syndrome rash, CBC, liver panels, and serum glucose; toxic manifestations progress from nystagmus (above $20\,\mu\text{g/mL}$) to ataxia and slurred speech (above $30\,\mu\text{g/mL}$), followed by lethargy and coma (above $40\,\mu\text{g/mL}$).

Lamotrigine

An antiepileptic and bipolar maintenance drug that requires slow upward dose titration and immediate discontinuation at the first sign of cutaneous rash due to the risk of life-threatening Stevens-Johnson syndrome; serum concentrations are significantly increased by coadministration with valproic acid.

Cyclobenzaprine

A short-term, centrally acting skeletal muscle relaxant related to tricyclic antidepressants that induces sedation, dizziness, dry mouth, constipation, urinary retention, and tachycardia; contraindicated in clients with cardiac disorders, urinary retention, or glaucoma.

Cholinergic Toxicity (SLUDGE)

A toxic syndrome caused by excessive parasympathetic stimulation presenting with Salivation, Lacrimation, Urination, Diarrhea, GI cramps, and Emesis, accompanied by bradycardia and bronchospasm; reversed with intravenous atropine.

Bethanechol

A direct-acting cholinergic agonist utilized postoperatively to treat nonobstructive urinary retention, evidenced as therapeutically effective when the patient voids within approximately $60\,\text{minutes}$ of administration.

Lithium

A first-line mood stabilizer for bipolar disorder maintaining a therapeutic window of $0.5\text{--}1.2\,\text{mEq/L}$ (or $0.6\text{--}1.2\,\text{mEq/L}$); early toxicity occurs at $1.5\text{--}2.0\,\text{mEq/L}$ (vomiting, diarrhea, coarse tremor) and severe toxicity occurs above $2.0\,\text{mEq/L}$, precipitated by hyponatremia, dehydration, diuretics, ACE inhibitors, and NSAIDs.

Bupropion

A norepinephrine-dopamine reuptake inhibitor (NDRI) indicated for major depression, seasonal affective disorder, and smoking cessation (Zyban); it does not cause sexual dysfunction or weight gain but carries a dose-dependent risk of seizures at dosages exceeding $450\,\text{mg/day}$.

Monoamine Oxidase Inhibitors (MAOIs)

Third-line antidepressant agents that prevent the breakdown of norepinephrine, serotonin, and dopamine; carrying severe risks of fatal hypertensive crisis when combined with dietary tyramine or decongestants, and serotonin syndrome when combined with SSRIs without a $14\text{--}\text{day}$ washout period.

Tyramine Dietary Restrictions

A strict regimen maintained during and for $2\,\text{weeks}$ following MAOI therapy that prohibits aged cheeses, cured/smoked/processed meats, pickled or fermented foods, soy sauce, overripe bananas/avocados/raisins/fava beans, beer, and red wine to avoid catastrophic hypertensive crises.

Alprazolam

A short-acting benzodiazepine that enhances the inhibitory action of GABA to treat anxiety disorders; clients must be monitored for sedation, ataxia, respiratory depression, and dependence, avoid alcohol, and undergo gradual tapering to prevent withdrawal seizures.

Moderate Anxiety Teaching Strategy

Educational interventions designed for a patient whose perceptual field is narrowed but who can still learn with guidance, utilizing a calm, quiet environment, staying at the bedside, delivering short, simple instructions one at a time with repetition, providing written materials, and seeking return demonstrations.

Risperidone

A second-generation atypical antipsychotic indicated as a first-line agent for schizophrenia to treat positive and negative symptoms; adverse effects include substantial weight gain, hyperglycemia, dyslipidemia, hyperprolactinemia, orthostatic hypotension, and extrapyramidal symptoms.

Clozapine

A second-generation atypical antipsychotic requiring immediate drug cessation and complete blood count testing if the patient develops signs of infection such as a sore throat or fever, due to the risk of severe agranulocytosis.

Haloperidol

A first-generation antipsychotic and dopamine antagonist used in schizophrenia and Tourette syndrome that commonly induces extrapyramidal symptoms (dystonia, akathisia, pseudoparkinsonism, tardive dyskinesia), neuroleptic malignant syndrome, $\text{QT}$ prolongation, orthostatic hypotension, and benign pink or red-brown urine.

CNS Stimulants (ADHD)

First-line sympathomimetic agents (such as methylphenidate and amphetamines) prescribed to manage hyperactivity and inattention; they require monitoring of appetite suppression, weekly weights, growth, sleep patterns, and vitals, and must be scheduled $30\text{--}45\,\text{minutes}$ before meals and at least $6\,\text{hours}$ before bed.

Medication Abuse Indicators

Clinical and behavioral patterns indicative of substance abuse, including doctor shopping across multiple prescribers or pharmacies, early refills, reporting lost prescriptions, asking for high dosages, behavioral volatility, alongside drug-specific physical findings such as miosis or stimulant-induced mydriasis and insomnia.

Alcohol Withdrawal Timeline

A predictable progression of symptoms following alcohol cessation: mild tremors, anxiety, diaphoresis, and autonomic hyperactivity occur at $6\text{--}24\,\text{hours}$; withdrawal seizures appear at $12\text{--}48\,\text{hours}$; and delirium tremens emerges at $48\text{--}72\,\text{hours}$.

Wernicke Encephalopathy Prophylaxis

A protocol in acute alcohol withdrawal requiring parenteral administration of thiamine before intravenous glucose solutions to avoid precipitating acute neurological damage, followed by benzodiazepine therapy (chlordiazepoxide, lorazepam) for sedation and seizure control.

Anaphylaxis Emergency Management

A prioritized resuscitation sequence beginning with stopping the offending trigger, immediately injecting intramuscular epinephrine ($0.3\text{--}0.5\,\text{mg}$ into the anterolateral thigh repeated every $5\text{--}15\,\text{minutes}$ as needed), and providing oxygen, IV fluids, H1/H2 blockers, inhaled albuterol, and systemic corticosteroids.

Sumatriptan

A serotonin $5\text{--}\text{HT}_1$ receptor agonist that aborts acute migraines through cranial vasoconstriction; adverse reactions include facial flushing, tingling sensations, elevated blood pressure, and substernal chest tightness or pressure caused by coronary vasospasm.

Ibuprofen vs Naproxen Sodium

Nonsteroidal anti-inflammatory agents differentiated by pharmacokinetics: ibuprofen is short-acting, dosed every $4\text{--}6\,\text{hours}$, and best suited for acute pain and pyrexia; naproxen sodium is long-acting, dosed every $8\text{--}12\,\text{hours}$, and preferred for chronic inflammatory conditions such as arthritis and dysmenorrhea.

Albuterol Administration Technique

A stepwise procedure for a short-acting beta-2 agonist rescue inhaler: shake the canister, exhale fully, inhale deeply and slowly while depressing the canister, hold breath for $10\,\text{seconds}$, wait $1\,\text{minute}$ before a second puff, and always administer before inhaled corticosteroid doses.