Nursing Pharmacology Final Exam actual questions with 100% correct answers + detailed explanations

Drug

any chemical that affects living processes

Pharmacology

the study of drugs and their effects on living processes (plants, body tissues, etc.)

Clinical Pharmacology

the study of drugs in HUMANS

Pharmacotherapeutics

the use of drugs to diagnose, prevent, and treat illnesses as well as to prevent pregnancy

Minimal Effective Concentration

the smallest dose of a drug that produces the desired effect

Toxic Concentration

the dose of a drug that produces toxic effects

Therapeutic Range

between the MEC & the TC; gets desired effect(s) from drug without toxic side effects

P450 System

an enzyme that alters drug metabolism

-accelerates renal excretion

-inactivates drug

-enhances drug

-activates prodrugs

Prodrugs

drugs that are not activated (inert) until they pass through the liver

First-pass Effect

deactivation of drug by liver after GI absorption

Drug Half-Life

time it takes for drug levels to decrease by 50%

-it takes five half-lives to maintain a normal therapeutic range

Loading Dose

drugs with short half-lives get a larger initial dose in order to achieve therapeutic range

Maintenance Dose

small doses given to maintain therapeutic range

ED50 (Average Effective Dose)

the dose that produces the desired effects in 50% of the population

Therapeutic Index

= LD50 / ED50

-average lethal dose / average effective dose

-the higher the number, the safer the drug

Alpha1 Receptors

Sympathetic

-Adrenergic Receptor

-vasculature

-vasoconstriction

-pupil dilation

-ejaculation

-bladder neck contraction

Alpha2 Receptors

Sympathetic

-Adrenergic Receptor

-minimal

Beta1 Receptors

Sympathetic

-Adrenergic receptor

-heart & kidney

-increase HR, force of contraction & velocity of conduction

-Renin release

Beta2 Receptors

Sympathetic

-Adrenergic receptor

-bronchodilation

-relaxation of uterine muscle

-glycogenolysis

Nicotinic n

Paraympathetic

-cholinergic receptor

-promotes release of epinephrine

Nicotinic m

Parasympathetic

-cholinergic receptor

-contraction of skeletal muscle

M1 Receptor

Parasympathetic

-cholinergic receptor

-muscarinic

-salivary/CNS

-increases salivation and cognition

M2 Receptor

Parasympathetic

-cholinergic receptor

-muscarinic

-heart

-bradycardia

M3 Receptor

Parasympathetic

-cholinergic receptor

-muscarinic

-salivary, GI, bladder, eye

-increases salivation

-increases gastric secretions, tone & motility

-contracts detrussor muscle

-pupil constriction

drug of choice for bradycardia?

ATROPINE

-given for muscarinic poisoning (mushrooms)

-anti-cholinergic

-muscarinic antagonist

-increases HR

-increases secretions (good for pre-anesthesia)

-dilates pupils (eye surgery)

Myesthenia Gravis

auto-immune process against nicotinic m receptors on skeletal muscle

-muscle weakness (including respiratory muscles)

Neostigmine/Prostigmin

myesthenia gravis

-inhibits ACh

-works peripherally

Parkinson's disease

neurodegenerative disorder

-loss of dopaminergic neurons in basal ganglion

-decreased dopamine

-rigidity, mask-like face, tremor, instability, bradykinesia

Levodopa/Dopar

Parkinson's disease

-precursor to dopamine

-metabolized into dopamine in the brain

-only 2% makes it into brain

-initially effective but diminishes over time due to advancement of disease & tolerance

-side effects: N/V, hypotension, dysrhythmias

-do not give to patients taking MAO-inhibitors (can cause hypertensive crisis)

Sinemet

Parkinson's disease

LEVODOPA + CARBIDOPA

-Carbidopa blocks metabolizing of Levodopa in gut

-allows more to gross BBB into the CNS

-able to decrease Levodopa dose

Dopamine Agonists

Parkinson's disease

-increases activation of dopamine receptors

-less effective than dopamine itself

Dopamine Agonists: Ergot Derivatives

Parkinson's disease

-less selective for dopamine receptors

-more side effects

Dopamine Agonists: Non-Ergot Derivatives

Parkinson's disease

-more selective for dopamine receptors

-less side effects

Alzheimer's Disease

Neurodegenerative disorder

-progressive memory loss

-neuromotor decline

-starts in Hippocampus (limbic system) and progresses to cerebral cortex

Cholinesterase Inhibitors

Alzheimer's disease

-for mild symptoms

-prevent breakdown of ACh

-patients don't respond well

-cholinergic side effects (dec. HR & BP, diarrhea, salivation)

NMDA Receptor Antagonists

Alzheimer's disease

-for severe symptoms

-better tolerated than CI

-decrease in symptoms, may slow progress

-blocks flow of calcium into memory cells

Procaine/Novocain

Lidocaine/Xylocaine

Local anesthetics

-Novocain -> metabolized in blood

-Xylocaine -> metabolized in liver

-pain lost first, then temp, touch, & deep pressure

-DO NOT USE CENTRALLY!!! May effect cardiac function

-give with epinephrine to contain drug at site (vasoconstriction)

Propofol/Diprivan

Anesthetic

-lipid-based

-conscious sedation

-hypotension & risk for infection (because of lipid-based nature)

-given IV

Narcotics

opioid analgesics

-analgesia, resp. depression, sedation, euphoria, constipation, vasodilation

-be careful with possible dependence

-Morphine, Dilaudid, Oxycodone/Percocet

antidote for narcotic overdose?

NALOXONE

two types of drugs for Asthma?

anti-inflammatory & bronchodilation

Glucocorticoids for Asthma

anti-inflammatory action

-given via inhalation to decrease systemic effects

-IV push for emergency

-PO can cause adrenal insufficiency (wean off)

prophylaxis for chronic asthma

Leukotriene Modifiers for Asthma

anti-inflammatory action

-suppress actions of leukotriene (bronchoconstriction, edema)

-can cause liver toxicity

Cromolyn/Intal for Asthma

anti-inflammatory action

-suppresses bronchial inflammation

-inhibits inflammatory cells

-decreases release of histamine

-not for acute episodes, for prophylaxis BEFORE EXERCISE

Beta2 Agonists for Asthma

bronchodilation

-combine with inhaled glucocorticoids

-relaxes smooth muscle

Albuterol/Pronventil

SABA (for Asthma)

-use for acute attacks

-immediate

-lasts 3-5 hrs

Salmeterol/Serevent

LABA (for Asthma)

-given DPI (dry-powder inhaler)

-mortality r/t excessive use

-lasts 12 hrs

-prophylactic

Natriuretic Peptides

for hypertension

-responds to fluid overload

-vasodilation

-reduces blood volume

-may get overwhelmed by HF progression

ACE Inhibitors

Hypertension, HF, MI/stroke prevention

"-PRILS"

-pro-drug

-reduce dose in renal disease/toxicity

-vasodilation. stops production of angiotension II (& therefore aldosterone) which decreases blood volume

-first-dose hypertension, fetal injury (not given to pregnant women)

giving ACE Inhibitors will cause renal failure in patients with __________________.

renal artery stenosis

If we inhibit ACE, we inhibit _______, therefore promoting ______________

-inhibit Kinase II

-promotes Bradykinin

-will cause angioedema and a barky cough

Calcium Channel Blockers

hypertension

-decreases BP via vasodilation

-2 kinds

Procardia

Calcium Channel Blocker

-affects arterioles

-angina, hypertension, migraine prophylaxis

-acts on arteriole smooth muscle (vasodilation)

-reflex tachycardia

Cardizem

Calcium Channel Blocker

-affects arterioles & heart

-vasodilation

-decreases rate, force of contraction & velocity of conduction

-no reflex tachycardia (because of affect on heart)

drug of choice for atrial fibrillation?

DELTIAZEM/CARDIZEM

Beta Blockers

used for hypertension, HF, dysrhythmias

-NEVER GIVE BETA BLOCKERS TO A PATIENT WITH AN AV HEART BLOCK!!!!!!!!!!!!!!!

Selective Beta Blockers

works only on beta1 receptors (only on heart)

-Metoprolol

Nonselective Beta Blockers

works on both beta1 & 2 receptors

-cheap

-but have to worry about effects on lungs

Nitroglycerin

ANGINA

-acts directly on vascular smooth muscle

-dilation of arterioles

-side effects: hypotension, headache

-sublingual is best

-oral for prophylaxis

-IV for short-term use only

-transdermal -> remove patch at night (period of least activity)

Heparin

Anti-Coagulant

-given IV

-monitor PTT (prolonged thromboplastin time)

-risk for bleeding

-HIT (Heparin-induced thrombocytopenia)

antidote for heparin?

protamine sulfate

Low Molecular Weight Heparins

-administered SC

-do not have to monitor levels

-can be done at home

Warfarin/Coumadin

Anti-Coagulant

-given PO

-vitamin k antagonist

-monitor PT (prothrombin time)

antidote for Warfarin/Coumadin?

vitamin K

Plavix

Anti-Platelet

-prevents platelet aggregation

-risk for bleeding

Glycoprotein IIb/IIIa Receptor Antagonist

-reversible blocking to prevent aggregation

-IV short-term in combo with ASA & Heparin

-Abciximab/ReoPro

Pletal

-platelet inhibitor for INTERMITTENT CLAUDICATION

Persantin

-used for prevention of thromboembolism FOLLOWING A HEART VALVE REPLACEMENT

Lasix

Loop Diuretic

-VERY high urine output; hypokalemia

Thiazide Diuretics

-high urine output

-need good renal function

-do not give to patients with gout

Potassium-Sparing Diuretics

Aldactone

-often used in combo with Lasix to save K+

-small urine output

-preserves K+

Osmotic Diuretics

Mannitol

-moves intracellular fluid into vascular space

-must be given IV

-inhibits reabsorption of H2O

-cerebral edema

Statins (HMG-CoA Reductase Inhibitors)

-reduce LDL & increases HDL

-take in evening (most cholesterol production is done at night)

-every-other-day dosing is used to manage side effects

-side effects: MYOPATHY & muscle pain

drug of choice for hypertensive emergencies?

NIPRIDE

drug of choice for SVT (supraventricular tachycardia)?

ADENOSINE

-quickly in repeated IV Push doses

-follow with normal saline

drug of choice for anaphylaxis?

EPINEPHRINE

Type I Diabetes

Insulin-Dependent Diabetes

-no insulin produced

Type II Diabetes

non-Insulin Dependent Diabetes

-strongly related to obesity

-insulin resistance or impaired insulin secretion

Humalog / Novolog

Short Duration: Rapid-Acting

-bolus

-clear preparations

-given with meals

-SC & via pump

Humulin / Novolin

Short Duration: Slower Acting

-clear prepartions

-SC, IM, IV, and via pump

-given with meals

Novolin N / Humulin N

Intermediate Acting

-NPH (cloudy preparations)

-SC only

Levemir / Lantus

Long-Duration

-DO NOT MIX

-lasts 24 hours

-clear

-SC only

Sulfonylureas

PO DM Drug

-Type I

-promote insulin by pancreas

-caution in patients with sulfa allergy!

Meglitinides (Glinides)

PO DM Drug

-promote insulin secretion by the pancreas

-take with meals 2-3 times a day

-DO NOT USE WITH LOPID (A STATIN)!!!!!!!!!!!!!!!!!!!!!!!

oral drug of choice for diabetes??

Biguanides

Biguanides

PO DM Drug

-METFORMIN

-Type II Diabetes

-decrease glucose production by liver

-increase glucose uptake by muscle

-GI side effects (diarrhea)

-off-label use for polycystic ovarian syndrome

Thiazolidinediones (Glitazones/TZDs)

PO DM Drug

-add-on for biguanides

-decreases insulin resistance (type II)

-need insulin present to work

-weight gain r/t fluid retention

Alpha-Glucosidase Inhibitors

PO DM Drug

-inhibits carbohydrate digestion/absorption

-decreases postprandial hyperglycemia

-side effects: flatulence, cramps, diarrhea

DPP4 Inhibitors (Gliptins)

PO DM Drug

-enhances action of incretin

-inhibits glucagon

-adverse effects: pancreatic cancer, pancreatitis

GLP-1 Receptor Agonists

PO DM Drug

-Incretin mimetic

-only available SC

-hypoglycemia/pancreatitis

Symlin

PO DM Drug

-type I & II

synthetic amylin

-side effects: nausea, weight loss, severe hypoglycemia

Sodium Glucose Cotransporter 2 (SGLT2) Inhibitors

PO DM Drug

-"peeing out glucose"

-newest class of PO medications

Histamine 2 Receptor Blockers

Peptic Ulcers

-Tagamet

-suppress secretion of gastric acid

-H2 receptors in the parietal cells of stomach

-CNS side effects (confusion, CNS depression/excitation)

-pneumonia is common side effect

Proton Pump Inhibitors (PPIs)

Peptic Ulcers

"-prazole"

-most effective in suppressing gastric acid secretion

-blocks generation of acid

-IRREVERSIBLE (lasts longer!)

-side effects: rebound hypersecretion, c diff, hypermagnesemia

Sucralfate/Carafate

Peptic Ulcers

-inert

-provides protective barrier between acid & epithelium

-may effect absorption of other drugs (dilantin, warfarin, etc.)

Antacids

-alkaline compounds

-neutralize gastric acids (bring pH up)

which antacids can cause diarrhea?

MAGNESIUM compounds

which antacids can cause constipation?

ALUMINUM compounds

Group I Laxatives

water stool in 2-6 hours

Group II Laxatives

semi-fluid stool in 6-12 hours