NUR 331: EXAM 2 NEED TO KNOW

Thyroid Hormones

Hormones that regulate metabolism, growth, development, and cellular respiration through gene regulation at nuclear receptors; Includes T4 (thyroxine) and T3 (triiodothyronine).

Levothyroxine Sodium - T4 (Levothroid; Synthroid; Levoxyl)

Class: Thyroid Hormone

Mechanism: Converted intracellularly to T3 and binds nuclear receptors to regulate gene expression and metabolism

Uses: Hypothyroidism

Adverse Effects: Tachycardia, palpitations, insomnia, weight loss, and heat intolerance with excessive dosing

Black Box Warning: Not for obesity or weight loss; Nursing

Considerations: Take before breakfast, avoid switching brands, and monitor response over 6-8 weeks.

Triiodothyronine (T3)

Class: Thyroid Hormone; Mechanism: Active thyroid hormone that binds nuclear receptors and regulates gene expression; Uses: Short-term treatment of myxedema and TSH suppression; Characteristics: More potent and faster acting than T4.

Thioamides

Class of antithyroid drugs that inhibit thyroid hormone synthesis; Uses: Hyperthyroidism; Adverse Effects: Agranulocytosis and hepatotoxicity; Drugs: Methimazole and Propylthiouracil (PTU).

Methimazole (Tapazole)

Class: Thioamide; Mechanism: Inhibits thyroid peroxidase and thyroid hormone synthesis; Uses: Hyperthyroidism; Adverse Effects: Agranulocytosis, rash, and nausea; Nursing Considerations: Monitor WBC count and discontinue therapy if agranulocytosis develops.

Methimazole Treatment-Terminating Adverse Effect

Agranulocytosis.

Propylthiouracil (PTU)

Class: Thioamide; Mechanism: Inhibits thyroid hormone synthesis and peripheral conversion of T4 to T3; Uses: Hyperthyroidism; Adverse Effects: Agranulocytosis and hepatitis; Nursing Considerations: Monitor liver function and signs of infection.

Propylthiouracil (PTU) Black Box Warning

Severe liver injury and hepatitis.

Radioactive Iodide

Class: Antithyroid Agent; Mechanism: Destroys thyroid tissue and decreases thyroid hormone production; Uses: Hyperthyroidism; Adverse Effects: Hypothyroidism may occur following treatment.

Corticosteroids

Class of hormones and medications that regulate inflammation, metabolism, immune responses, and stress adaptation; Includes glucocorticoids and mineralocorticoids.

Glucocorticoids

Class of corticosteroids that regulate metabolism and suppress inflammation and immune responses; Uses: Allergic disorders, inflammatory diseases, autoimmune disorders, organ transplantation, and adrenal insufficiency.

Dexamethasone (Decadron)

Class: Glucocorticoid; Mechanism: Suppresses inflammatory and immune responses; Uses: Allergic disorders, inflammatory diseases, autoimmune disorders, and immunosuppression; Adverse Effects: Hyperglycemia, infection risk, fluid retention, osteoporosis, delayed wound healing, weight gain, and body image changes; Nursing Considerations: Do not discontinue abruptly and monitor for infection and hyperglycemia.

Glucocorticoid Withdrawal Risk

Abrupt discontinuation may precipitate adrenal insufficiency.

Alternate-Day Corticosteroid Therapy

Administration strategy used to reduce adrenal suppression and decrease adverse effects.

Mineralocorticoids

Class of corticosteroids that regulate sodium, potassium, and water balance.

Fludrocortisone (Florinef)

Class: Mineralocorticoid; Mechanism: Promotes sodium and water retention and influences potassium balance; Uses: Adrenal insufficiency; Adverse Effects: Fluid retention and electrolyte disturbances.

Cushing Syndrome

Condition caused by excessive exposure to corticosteroids or excess cortisol.

Cause of Drug-Induced Cushing Syndrome

Excessive glucocorticoid therapy.

Signs and Symptoms of Cushing Syndrome

Weight gain, fluid retention, hyperglycemia, body image changes, and manifestations of excess cortisol.

Nursing Considerations for Corticosteroids

Monitor for infection, monitor blood glucose, assess fluid status, taper therapy appropriately, and monitor for signs of Cushing syndrome.

Histamine

Endogenous compound released from mast cells and basophils that mediates allergic reactions and gastric acid secretion; Effects include bronchoconstriction, nasal congestion, edema, itching, and increased gastric acid secretion.

H1 Antagonists

Class of antihistamines that block H1 receptors and reduce the effects of histamine; Uses: Allergic disorders, motion sickness, insomnia, and common cold symptoms; Adverse Effects: Sedation, dizziness, fatigue, confusion, nausea, vomiting, constipation, and anticholinergic effects.

First-Generation H1 Antagonists

Readily cross the blood-brain barrier and commonly cause sedation and anticholinergic effects; Drugs: Diphenhydramine and Promethazine.

Diphenhydramine (Benadryl)

Class: First-Generation H1 Antagonist; Mechanism: Blocks H1 receptors; Uses: Allergic rhinitis, conjunctivitis, dermatitis, motion sickness, insomnia, and parkinsonism; Adverse Effects: Drowsiness, sedation, agitation in children, anticholinergic effects, and hypotension with rapid IV administration; Nursing Considerations: Monitor for drug interactions and assess symptom relief.

Promethazine (Phenergan)

Class: First-Generation H1 Antagonist; Mechanism: Blocks H1 receptors; Uses: Nausea, vomiting, motion sickness, and allergic conditions; Adverse Effects: Sedation and anticholinergic effects; Black Box Warning: Chemical irritation and severe tissue damage regardless of route of administration.

Second-Generation H1 Antagonists

Less sedating antihistamines due to reduced penetration of the blood-brain barrier; Drugs: Cetirizine and Loratadine.

Cetirizine (Zyrtec)

Class: Second-Generation H1 Antagonist; Mechanism: Blocks H1 receptors; Uses: Seasonal allergies and urticaria; Adverse Effects: Headache, dizziness, nausea, vomiting, and fatigue.

Loratadine (Claritin)

Class: Second-Generation H1 Antagonist; Mechanism: Blocks H1 receptors; Uses: Seasonal allergies and urticaria; Adverse Effects: Headache, dizziness, nausea, vomiting, and fatigue.

Third-Generation H1 Antagonists

Least sedating antihistamines because of minimal penetration into the central nervous system; Drugs: Fexofenadine and Levocetirizine.

Fexofenadine (Allegra)

Class: Third-Generation H1 Antagonist; Mechanism: Blocks H1 receptors; Uses: Seasonal allergies and urticaria; Adverse Effects: Headache, nausea, vomiting, fatigue, and dysmenorrhea.

Levocetirizine (Xyzal)

Class: Third-Generation H1 Antagonist; Mechanism: Blocks H1 receptors; Uses: Seasonal allergies and urticaria; Adverse Effects: Headache, nausea, vomiting, fatigue, and dysmenorrhea.

β2 Adrenergic Receptor Agonists

Class of bronchodilators that activate β2 receptors in bronchial smooth muscle causing bronchodilation; Uses: Asthma and COPD.

Short-Acting Beta Agonists (SABAs)

Rapid-acting bronchodilators used for acute asthma symptoms and rescue therapy.

Albuterol (Proventil, ProAir)

Class: Short-Acting β2 Agonist (SABA); Mechanism: Activates β2 receptors causing bronchodilation; Uses: Acute asthma attacks and bronchospasm; Adverse Effects: Tachycardia, palpitations, anxiety, irritability, insomnia, and tremor; Precautions: Use cautiously in patients with cardiovascular disease and older adults.

Long-Acting Beta Agonists (LABAs)

Longer-acting bronchodilators used for maintenance and prophylactic therapy.

Salmeterol (Serevent)

Class: Long-Acting β2 Agonist (LABA); Uses: Maintenance and prophylaxis of asthma and COPD.

Advair

Class: Combination LABA and Inhaled Corticosteroid; Components: Salmeterol and Fluticasone; Uses: Maintenance therapy for asthma and COPD; Adverse Effects: Tachycardia, palpitations, angina, hypertension, anxiety, irritability, insomnia, and tremor.

Muscarinic Antagonists

Class of bronchodilators that block muscarinic acetylcholine receptors and prevent bronchoconstriction.

Tiotropium (Spiriva)

Class: Long-Acting Muscarinic Antagonist (LAMA); Mechanism: Blocks muscarinic receptors and prevents acetylcholine-induced bronchoconstriction; Uses: Maintenance therapy for COPD and asthma; Adverse Effects: Cough, nervousness, nausea, GI upset, headache, and dizziness; Advantage: Poor systemic absorption limits adverse effects.

Methylxanthines

Class of bronchodilators that relax bronchial smooth muscle; Drug: Theophylline.

Theophylline (Bronkodyl)

Class: Methylxanthine Bronchodilator; Mechanism: Relaxes bronchial smooth muscle; Uses: Prevention of bronchoconstriction in severe disease not controlled by first-line agents; Adverse Effects: Anxiety, restlessness, insomnia, nausea, arrhythmias, and convulsions; Precautions: Use cautiously in children, older adults, and patients with ulcers or cardiovascular disease; Nursing Considerations: Narrow therapeutic range and avoid excess caffeine.

Leukotriene Modifiers

Class of drugs that block leukotriene receptors resulting in bronchodilation and reduced airway inflammation.

Montelukast (Singulair)

Class: Leukotriene Modifier; Mechanism: Blocks leukotriene receptors causing bronchodilation and reduced airway inflammation; Uses: Asthma prevention and allergic rhinitis; Adverse Effects: Headache and GI upset; Black Box Warning: Neuropsychiatric events including agitation, aggression, anxiety, hallucinations, suicidal ideation, and tremor.

Monoclonal Antibodies

Biologic agents that target specific inflammatory mediators involved in asthma.

Omalizumab (Xolair)

Class: Monoclonal Antibody; Mechanism: Targets IgE antibodies on mast cells and basophils reducing release of inflammatory mediators; Uses: Adjunct therapy for moderate-to-severe persistent allergic asthma; Administration: Subcutaneous injection every 2-4 weeks; Adverse Effects: Injection-site reactions, headache, nausea, fatigue, and anaphylaxis.

Antiemetics

Class of medications used to prevent or treat nausea and vomiting by acting on neurotransmitter pathways involved in the vomiting reflex.

Phenothiazines

Class of antiemetics that block dopamine (D2) receptors and suppress stimulation of the vomiting center; Uses: Nausea and vomiting associated with surgery, anesthesia, chemotherapy, migraines, and motion sickness; Adverse Effects: Dry mouth, blurred vision, urinary retention, constipation, confusion, dizziness, tachycardia, and respiratory depression.

Promethazine (Phenergan)

Class: Phenothiazine Antiemetic and First-Generation H1 Antagonist; Mechanism: Dopamine receptor blockade and H1 receptor blockade; Uses: Nausea, vomiting, motion sickness, and allergic conditions; Adverse Effects: Sedation and anticholinergic effects; Black Box Warning: Chemical irritation and severe tissue damage regardless of route of administration.

Prochlorperazine (Compazine)

Class: Phenothiazine Antiemetic; Mechanism: Dopamine receptor antagonist; Uses: Nausea and vomiting; Adverse Effects: Anticholinergic effects, confusion, dizziness, tachycardia, and sedation.

Antihistamine Antiemetics

Class of antiemetics that block H1 receptors and reduce stimulation of the vomiting center; Uses: Motion sickness, postoperative nausea, anesthesia-related nausea, and general nausea/vomiting; Adverse Effects: Drowsiness, dizziness, confusion, dry mouth, blurred vision, urinary retention, constipation, and tachycardia.

Hydroxyzine

Class: Antihistamine Antiemetic; Mechanism: H1 receptor blockade; Uses: Nausea, vomiting, motion sickness, and anesthesia-related nausea; Adverse Effects: Drowsiness, dizziness, confusion, dry mouth, blurred vision, urinary retention, constipation, and tachycardia.

Diphenhydramine (Antiemetic Use)

Class: Antihistamine Antiemetic; Mechanism: H1 receptor blockade; Uses: Motion sickness, nausea, and vomiting; Adverse Effects: Sedation and anticholinergic effects.

5-HT3 Receptor Antagonists

Class of antiemetics that block serotonin (5-HT3) receptors involved in the vomiting reflex; Uses: Chemotherapy-induced, radiation-induced, and postoperative nausea and vomiting.

Ondansetron (Zofran)

Class: 5-HT3 Receptor Antagonist; Mechanism: Blocks serotonin receptors in the GI tract and central nervous system; Uses: Chemotherapy-induced, radiation-induced, and postoperative nausea and vomiting; Adverse Effects: QT prolongation, headache, diarrhea, and constipation.

QT Prolongation

Important adverse effect associated with ondansetron therapy.

Substance P / Neurokinin-1 (NK1) Antagonists

Class of antiemetics that block substance P activity in the vomiting center; Uses: Prevention of chemotherapy-induced nausea and vomiting.

Aprepitant (Emend)

Class: NK1 Receptor Antagonist; Mechanism: Blocks substance P from binding to neurokinin-1 receptors; Uses: Prevention of chemotherapy-induced nausea and vomiting.

Pregnancy Antiemetics

Medications used to treat nausea and vomiting during pregnancy while minimizing fetal risk.

Diclegis

Class: Combination Antiemetic; Components: Doxylamine Succinate and Pyridoxine (Vitamin B6); Uses: Nausea and vomiting during pregnancy; Significance: One of the few FDA-approved medications specifically indicated for nausea and vomiting during pregnancy.

Antiemetic Administration Timing

Most effective when administered prophylactically before symptoms begin.

Antiemetic Route Considerations

During active vomiting, rectal, intravenous, or other parenteral routes may be preferred.

Nursing Considerations for Antiemetics

Monitor hydration status, assess effectiveness, monitor for sedation and anticholinergic effects, and implement safety precautions for dizziness and drowsiness.

Antiulcer Drugs

Class of medications used to decrease gastric acid secretion, neutralize gastric acid, protect the gastric mucosa, and promote ulcer healing.

Antacids

Class of medications that neutralize gastric acid and increase gastric pH; Uses: Heartburn, GERD, gastritis, stress ulcers, and peptic ulcer disease; Adverse Effects: Constipation, diarrhea, and hypermagnesemia.

Mylanta

Class: Antacid; Mechanism: Neutralizes gastric acid; Uses: Heartburn, GERD, and peptic ulcer disease; Adverse Effects: Constipation, diarrhea, and hypermagnesemia; Nursing Considerations: Separate from other medications by 1-2 hours.

Tums

Class: Antacid; Mechanism: Neutralizes gastric acid; Uses: Heartburn, GERD, and peptic ulcer disease; Adverse Effects: Constipation and altered absorption of other medications; Nursing Considerations: Separate from other medications by 1-2 hours.

Histamine-2 Receptor Blockers (H2 Blockers)

Class of antiulcer drugs that inhibit H2 receptors on gastric parietal cells and decrease gastric acid secretion; Uses: PUD, GERD, esophagitis, GI bleeding, and ulcer healing.

Cimetidine

Class: H2 Receptor Blocker; Mechanism: Blocks H2 receptors on gastric parietal cells reducing acid secretion; Uses: PUD, GERD, and GI bleeding; Adverse Effects: Diarrhea, dizziness, confusion, and gynecomastia.

Famotidine (Pepcid)

Class: H2 Receptor Blocker; Mechanism: Blocks H2 receptors on gastric parietal cells reducing acid secretion; Uses: PUD, GERD, and esophagitis; Adverse Effects: Dizziness, drowsiness, and headache.

H2 Blocker Administration

Often administered at bedtime because nocturnal acid secretion is largely mediated by histamine.

Proton Pump Inhibitors (PPIs)

Class of antiulcer drugs that irreversibly inhibit gastric proton pumps and block the final step of acid production; Uses: GERD, gastric ulcers, duodenal ulcers, and peptic ulcer disease; Drugs of Choice for: GERD and PUD.

Omeprazole (Prilosec)

Class: Proton Pump Inhibitor; Mechanism: Irreversibly inhibits gastric proton pumps; Uses: GERD and peptic ulcer disease; Adverse Effects: Nausea, diarrhea, headache, and increased fracture risk with long-term use.

Mucosal Protective Agents

Class of antiulcer drugs that protect gastric mucosa and promote ulcer healing.

Sucralfate (Carafate)

Class: Mucosal Protective Agent; Mechanism: Binds to normal and ulcerated mucosa forming a protective barrier; Uses: Prevention and treatment of peptic ulcer disease; Adverse Effects: Constipation and dry mouth; Nursing Considerations: Administer on an empty stomach.

Bismuth Subsalicylate (Pepto-Bismol)

Class: Mucosal Protective Agent; Mechanism: Coats ulcers and protects them from acid; Uses: H. pylori treatment, indigestion, and heartburn; Adverse Effects: Black tongue and black stools.

Helicobacter pylori Therapy

Uses a combination of antibiotics and acid-suppressing therapy to eradicate H. pylori, promote ulcer healing, and reduce recurrence.

Common H. pylori Antibiotics

Clarithromycin, Metronidazole, Amoxicillin, and Tetracycline.

Laxatives

Class of medications used to ease or stimulate defecation and treat constipation.

Bulk-Forming Laxatives

Laxatives that function similarly to dietary fiber by increasing stool mass and stimulating peristalsis.

Psyllium (Metamucil)

Class: Bulk-Forming Laxative; Mechanism: Absorbs water, forms a gel, increases fecal mass, and stimulates peristalsis; Uses: Constipation and cholesterol reduction with dietary modification; Adverse Effects: Gas and bloating.

Stool Softeners (Surfactant Laxatives)

Laxatives that soften and lubricate stool by allowing water penetration into feces.

Docusate Sodium (Colace)

Class: Stool Softener; Mechanism: Decreases stool surface tension allowing water penetration; Uses: Prevention and treatment of constipation; Adverse Effects: Nausea and bitter taste.

Osmotic Laxatives (Saline Cathartics)

Laxatives that increase osmotic pressure within the intestine and retain water in the bowel; Adverse Effects: Cramping, dehydration, and abuse potential.

Magnesium Citrate

Class: Osmotic Laxative; Mechanism: Retains water in the intestine, softens stool, and stimulates peristalsis; Uses: Rapid bowel elimination; Adverse Effects: Cramping and dehydration.

Milk of Magnesia

Class: Osmotic Laxative; Mechanism: Retains water in the intestine, softens stool, and stimulates peristalsis; Uses: Rapid bowel elimination; Adverse Effects: Cramping and dehydration.

Osmotic Laxative Patient Teaching

Increase fluid intake during therapy.

Stimulant Laxatives (Cathartics)

Laxatives that irritate GI mucosa and increase intestinal motility and fluid secretion.

Bisacodyl (Dulcolax)

Class: Stimulant Laxative; Mechanism: Stimulates intestinal motility and fluid secretion; Uses: Constipation and bowel preparation; Adverse Effects: Abdominal cramping, nausea, and diarrhea.

Senna (Senokot)

Class: Stimulant Laxative; Mechanism: Stimulates bowel motility and increases fluid secretion; Uses: Opioid-induced constipation and bowel preparation; Adverse Effects: Abdominal cramping, diarrhea, nausea, and yellow-brown urine discoloration.

Opioid-Induced Constipation

Common complication of opioid therapy often treated with stimulant laxatives such as senna.

Opioid Agonists

Class of analgesics that bind and activate opioid receptors to produce analgesia; Major Adverse Effects: Respiratory depression, constipation, urinary retention, sedation, nausea, vomiting, hypotension, miosis, and physical dependence.

Morphine

Prototype Opioid Agonist; Mechanism: Activates opioid receptors, primarily mu receptors; Uses: Moderate to severe pain; Adverse Effects: Respiratory depression, constipation, urinary retention, sedation, miosis, hypotension, nausea, and vomiting; Nursing Considerations: Monitor respiratory rate, blood pressure, level of consciousness, and pain relief.

Hydromorphone (Dilaudid)

Class: Opioid Agonist; Mechanism: Activates opioid receptors; Uses: Moderate to severe pain; Characteristics: Approximately 5-7 times more potent than morphine; Adverse Effects: Respiratory depression, sedation, constipation, and dependence.

Fentanyl

Class: Opioid Agonist; Mechanism: Activates opioid receptors; Uses: Severe pain management; Adverse Effects: Respiratory depression, sedation, constipation, and dependence.

Meperidine

Class: Opioid Agonist; Mechanism: Activates opioid receptors; Uses: Pain management; Adverse Effects: Respiratory depression, sedation, constipation, and typical opioid adverse effects.

Methadone (Dolophine, Methadose)

Class: Long-Acting Synthetic Opioid Agonist; Mechanism: Activates opioid receptors and suppresses withdrawal symptoms; Uses: Chronic pain and opioid use disorder treatment; Adverse Effects: Abuse potential and QT prolongation; Nursing Considerations: Monitor for dysrhythmias and signs of overdose.

Methadone Use in Opioid Use Disorder

Reduces cravings and withdrawal symptoms and is administered through specialized opioid treatment programs.

Codeine

Class: Opioid Agonist; Mechanism: Activates opioid receptors; Uses: Pain management and cough suppression; Adverse Effects: Respiratory depression, sedation, constipation, and other opioid adverse effects.

Hydrocodone

Class: Opioid Agonist; Mechanism: Activates opioid receptors; Uses: Pain management and cough suppression; Characteristics: Frequently combined with acetaminophen.

Oxycodone

Class: Opioid Agonist; Mechanism: Activates opioid receptors; Uses: Pain management; Characteristics: Available alone or in combination with aspirin or acetaminophen.