Pharmacology Exam 1 2025

Six Step Nursing Process

Concept

Assessment

Patient Problems

Planning

Interventions

Evaluation

What to assess when administering medications

• Current and past medical history.

• Medication history (over the counter and prescription).

• Patient knowledge and understanding of medications.

• Cognitive and psychomotor disability.

• Subjective and objective data (labs, vitals, etc).

• Financial resources.

Whose job is it to obtain informed consent?

The physician.

Schedule 1 drugs

Substances that have high potential for abuse with no accepted medical use.

Schedule 2 drugs

Substances that have a high potential for abuse despite having medical use.

Schedule 3 drugs

Substances that have less potential for abuse than schedule 1 or 2 but abuse of the drugs can lead to moderate physical dependence or high psychological dependence.

Schedule 4 drugs

Substances that have less potential for abuse than schedule 3 and has medical use but may lead to limited physical dependence or little psychological dependence.

Schedule 5

Substances with limited amounts of narcotics that have less potential for abuse than schedule 4 and have an accepted medical use with limited risk of both physical and psychological dependence.

Pharmacodynamics

What the drug does to the body.

Pharmacokinetics

What our body does to the drug.

Concepts of pharmacokinetics

• Absorption

• Distribution

• Metabolism

• Excretion

Absorption

Process of drug transport from the site of administration to the systemic circulation crossing a biological membrane.

What factors impact absorption?

• Route of administration (PO, IM, IV, SubQ, etc)

• Dosage

• Digestive tract motility

• Digestive enzyme availability

• Drug to drug interaction

• Drug to food interactions

First pass effect

When a drug is absorbed from the GI tract and carried to the liver where it is extensively metabolized and only a little part of the drug reaches the circulation to be distributed.

Distribution

Transportation of drug molecules within the body, carried by blood or tissue fluids to the sites of action, metabolism, and excretion.

What factors impact distribution?

• Adequacy of circulation

• Protein binding

• Blood brain barrier

Metabolism

• Method of drug inactivation

• Primary site of metabolism is the liver.

• CYP450 is a liver enzyme that aids in the metabolism of drugs.

Pro Drug

A compound that is metabolized into an active pharmacologic substance.

Half life

The time it takes for the amount of the drug in the body to be reduced by half.

Excretion

• Eliminates drugs from the body, mostly excreted by the kidneys.

• Influenced by urine pH and renal function.

• Renal function tests: Creatinine, BUN, creatinine clearance.

Creatinine Lab Values

0.7-1.3

BUN Lab Values

8-21

Difference between side effects and adverse reactions

Side effects are expected, can be harmful or helpful.

Adverse reactions are undesired , unintended, or unexpected.

Ethnomedicine

Folk medicine, traditional medicine.

Ethnopharmacology

Healing remedies, herbs, powders, teas, etc.

Pharmacodynamics in pediatrics

• Body fat and available protein sites are different in peds than adults.

• There is variability in organ function, developmental factors, and issues with modes of administration.

Pharmacokinetics in pediatrics

• Organs are immature, so are body systems.

• There is reduced gastric acidity, irregular gastric emptying, thinner skin means that topical medications are absorbed easily.

• Distribution is affected because peds have more body water meaning that the concentration of the drug will be decreased.

• Metabolism is higher in peds.

• Excretion is affected due to immature kidneys in peds.

Family centered care in pediatrics

• Teach the family and the child.

• Understand cultural impacts.

• Develop rapport with patients.

• Allow parents to choose how involved they are with care.

Oral medications in pediatrics

Most common, should be in an oral syringe in small volumes pointed to the back of the cheek with flavoring if possible.

IM site for infants

Vastus Lateralis

Physiologic changes in geriatric patients

• Reduced liver size impacts hepatic clearance.

• Decreased blood flow to the kidneys reduces the clearance of drug excretion.

• GI slows down.

• Cardiovascular changes such as postural hypotension and decreased cardiac output.

• Many geriatric patients take multiple medications (polypharmacy).

Pharmacodynamics in geriatric patients

• Decreased receptors.

• Decreased affinity.

• Altered response to drugs related to CNS changes.

• Decreased compensatory mechanisms.

• Geriatric patients are at higher risk for adverse drug reactions, may need decreased doses, may need to increase the interval of doses.

Absorption in geriatric patients

Decreased acidity, motility, and blood flow.

Distribution in geriatric patients

Decreased protein binding sites, body water, and body fat.

Metabolism in geriatric patients

Decreased hepatic blood flow, decreased CYP450 enzymes.

Excretion in geriatric patients

Decreased kidney function.

Why are geriatric patients at risk for nonadherance?

• Polypharmacy.

• Economic factors.

• Lack of knowledge.

• Lack of symptoms.

• Physiologic impairment.

• Cognitive decline.

Alcohol absorption, metabolism, and excretion

• Absorbed into the bloodstream, mainly in the small intestine.

• Metabolized by the liver.

• Excreted in the urine, breath, and sweat.

Alcohol in pharmacology

• CNS depressant.

• Affects many neurotransmitters:

  • GABA

  • Glutamate

  • Dopamine

  • Opioid

Short term effects of alcohol

• Nausea

• Vomiting

• Headaches

• Slurred speech

• Impaired judgement

• Memory loss

• Hangovers

• Blackouts

Long term effects of alcohol

• Stomach issues

• Heart problems

• Cancer

• Brain damage

• Serious memory loss

• Immune system compromise

• Liver cirrhosis

Symptoms of alcohol toxicity

• Can’t communicate

• Slow or irregular heart rate

• Hypothermia

• Respiratory depression

• Coma

• Death

Effects of cocaine

• Increased energy and motor activity

• Increased heart rate and blood pressure

• Euphoria

• Decreased appetite

• Mental alertness

• Increased body temperature

• Dilated pupils

Therapeutic use of cocaine

• Topical anesthetic for ENT procedures

• Vasoconstrictor for bleeding

Cocaine toxicity

• Rapid heartbeat

• Hallucinations

• Paranoid delusions

• Tremors and convulsions

• Respiratory failure

• Heart attack or heart failure

• Stroke

Effects of methamphetamine

• Effects similar to cocaine

• Irritability and aggression

• Anxiety and or paranoia/nervousness

• Increased wakefulness

• Tremors or convulsions

• Decreased appetite

• Insomnia

• High blood pressure and increased heart rate

Methamphetamine toxicity

• Neurotoxic

• Permanent psychosis

• Hyperthermia

• Kidney failure

• Coma

• Stroke

• Heart attack

Rights of medication administration

1. Right patient

2. Right drug

3. Right dose

4. Right route

5. Right time

6. Right documentation

Pain definition

An unpleasant sensory and emotional experience related to tissue injury or disease. Pain is patient specific and is also seen as the fifth vital sign.

Non-pharmacologic pain management methods

• Massage

• Guided imagery

• Music therapy

• Heat or cold application

• Rest

• TENS units

• Meditation or prayer

• Relaxation techniques

• Acupuncture

• Physical therapy

• Pet therapy

Morphine sulfate MOA

Depression of pain impulses by binding with opiate receptors in the CNS.

Morphine sulfate use

Moderate to severe pain, sedation, cough supression.

Morphine sulfate SE

Respiratory depression, constipation, orthostatic hypotension, urinary retention, cough suppression, sedation, nausea and vomiting.

Morphine sulfate contraindications

CNS or respiratory depression, increased intracranial pressure (ICP), head injuries.

Morphine sulfate interactions

CNS depressants, anticholinergics, antihypertensives.

Morphine sulfate interventions

• Assess pain level at regular intervals.

• Monitor respiratory rate closely.

• Double check doses with another RN.

• Administer slowly.

• Have reversal agents like naloxone and resuscitative equipment available.

• Never abruptly stop medication.

Tramadol Classification

Norepinephrine and serotonin reuptake inhibitor

Tramadol MOA

Centrally acting analgesic, partially bonds to opioid receptors.

Tramadol use

Moderate to severe pain.

Tramadol considerations

Similar to morphine.

Naloxone classification

Opioid antagonist

Naloxone MOA

Competes for opioid receptors.

Naloxone use

Reversal of opioid overdose/opioid depression.

Naloxone SE

Tachycardia, abstinence syndrome.

Naloxone contraindications

Opioid dependency.

Naloxone considerations

• Half life of opioid may outlast the half life of naloxone.

• Monitor for withdrawal.

• May need to treat pain that returns.

• Monitor respiratory status.

Acetaminophen classification

Non opioid analgesic

Acetaminophen MOA

Weak inhibition of prostaglandin synthesis and the hypothalamic heat regulating center.

Acetaminophen use

Analgesic, antipyretic, not anti-inflammatory.

Acetaminophen SE

Rare with therapeutic doses.

Maximum 4 grams per day.

Acetaminophen precautions

Chronic alcohol use, severe liver or kidney impairment.

Acetaminophen interactions

Alcohol

Acetaminophen toxicity

• Results in liver damage.

• Nausea and vomiting.

• Dizziness.

• Sweating.

• Abdominal discomfort.

• Hepatic failure.

• Coma.

• Death.

Acetaminophen antidote

Acetylcysteine.

Normal acetaminophen levels

10-20 mcg.

Acetaminophen considerations

Monitor content of all over the counter medications, avoid alcohol.

Inflammation definition

A defense mechanism to tissue injury.

COX-1

Inhibition results in decreased platelt aggregation and kidney damage.

COX-2

Inhibition results in decreased inflammation, fever, and pain. Does not decrease platelet aggregation.

Ibuprofen classification

NSAIDs: Non-Steroidal Anti-Inflammatory Drugs

Ibuprofen MOA

Inhibits prostaglandin synthesis, the hypothalamic heat regulation center, and platelet aggregation.

Ibuprofen use

Anti-inflammatory, analgesic, and antipyretic.

Ibuprofen SE

GI upset, impaired kidney function, bleeding.

Ibuprofen contraindications

Peptic ulcer disease, bleeding disorders, pregnancy, surgery.

Ibuprofen interactions

Anticoagulants, glucocorticoids, alcohol, EGGOS.

Ibuprofen considerations

Take with food, monitor BUN/creatinine, monitor for bleeding, do not use long term.

Anesthetics are classified as either

Genreal or local

Which anesthetic depresses the CNS, alleviates pain, and causes loss of consciousness?

General anesthesia.

Lidocaine use

Nerve block, infiltration, epidural, and spinal anesthesia. Also used topically to treat pain and can be used for cardiac dysrhythmias.

Lidocaine modes of administration

Injection, patches, viscous lidocaine, gels, spray.

Midazolam MOA

Benzodiazepine; increases the action of GABA.

Midazolam Use

Anesthesia induction and maintenance.

Midazolam antidote

Flumazenil

Promethazine MOA

Blocks H1 receptor sites and inhibits and inhibits CTZ.

Promethazine Use

Treats or prevents motion sickness, nausea and vomiting, and sedation induction.

Promethazine SE

Sedation, hypotension, anticholinergic effects, respiratory depression.

Promethazine Interactions

CNS depressants, antiseizure drugs.

Promethazine Considerations

• May produce false pregnancy test results.

• Given the night before, the day of, and for 24 hours after cancer treatments.

• High alert drug.

Metoclopramide MOA

Blocks dopamine receptors and augments action of ACh to cause an increase in upper GI motility increasing peristalsis.

Metoclopramide Use

Nausea and vomiting, GERD, diabetic gastroparesis.