PHARMACOLOGY FINAL REVIEW

what is the difference between OTC and prescription drugs?

a physician’s order is not needed for OTC drugs

what are the 5 rights of medication?

• right patient

• right drug

• right dose

• right time

• right route

what are the stages of pharmacokinetics (4 stages)

1. absorption

2. distribution

3. metabolism

4. excretion

what is the definition of pharmacokinetics

how drugs move through the body (metabolizes)

what instructions to give for XL or extended release tablets?

do not crush or chew medication

(affects the therapeutic response)

what are side effects?

expected effect of the drug

what are adverse effects?

side effects that you must alert a physician if happening during treatment (EMERGENT)

what is the first pass effect?

concentration of drug is reduced before reaching systemic circulation

when you administer a medication orally what should you do with the doses

up the dosage due to the first pass effect

when you administer a medication IV/IM what should you do with the doses

lower the dosage due to the first pass effect

what is a black box warning on medication for?

a. show that the medication is limited to a certain age group

b. call attention to serious or life-threatening risks

c. to show that the medication has a certain ingredient in it

d. to show that the medication is an OTC drug

b. call attention to serious or life-threatening risks

what is a black box warning?

• an adverse effect that has nothing to do with the medication use

• worst thing that can happen when taking the drug

which group of people are most sensitive to medication effects?

a. infants

b. adults

c. women

d. older adults

e. infants and older adults

e. infants and older adults

what are the code of ethics for a nurse? (Select all that apply)

a. respect for human dignity

b. nurse advocates the rights, health, and safety of patients

c. a nurse focuses on virtues

d. focus on the dr’s opinion and not the patients

a. respect for human dignity

b. nurse advocates the rights, health, and safety of patients

c. a nurse focuses on virtues

what are 4 antibiotic medications?

• fluoroquinolones

• sulfonamides

• TB meds

• tetracyclines

what is patient teaching for antibiotic medications?

ALWAYS tell patients to finish the entire of course of antibiotics even if the patient feels better

what are nursing considerations for antimicrobials?

• half-life

• liver and renal function

• dose dependency (weight)

• time dependency (therapeutic level)

• route

• drug interactions

what is the priority assessment data for a client prescribed antibiotic therapy?

a. allergies

b. immunizations

c. surgical history

d. cardiac dysrhythmias

a. allergies

what medication is a sulfonamide?

sulfamethoxazole/trimethoprim (Bactrim DS)

what are sulfonamides used for?

used to treat UTIs, chronic bronchitis, travelers’ diarrhea, and skin infections

what are administration considerations of sulfamethoxazole/trimethoprim (Bactrim DS)? (2)

• skin reaction (Stevens-Johnson syndrome)

• contraindicated in pregnancy and breastfeeding mothers

what medications are fluoroquinolones? (4)

• ends in -floxacin

  • levofloxacin (levaquin)

  • ciprofloxacin (cipro)

  • moxifloxacin (avelox)

  • ofloxacin

what are fluoroquinolones used for?

used to treat pneumonia, complicated skin/urinary tract infections (often reserved for use in severe infections)

what is a black box warning for fluoroquinolones?

tendinitis/tendon rupture during treatment or months after discharge in all ages

what medications are tetracyclines? (3)

• ends in -cycline

  • doxycycline

  • minocycline

  • demeclocycline

what are tetracyclines used for?

acne treatment and to treat infections (pneumonia, gi infections, and lyme disease)

what is an administration consideration for tetracycline?

do not give to children less than 8 years old/pregnant women due to high risk of yellowing of the teeth

what are some patient teachings for tetracycline?

• avoid direct sunlight exposure

  • wear sunscreen due to photosensitivity

• avoid dairy products

  • impaired absorption of tetracycline with the use of dairy products

what are the antimycobacterial (TB) medications? (4)

• rifampin (rifadin)

• isoniazid (INH)

• pyrazinamide (PZA)

• ethambutol (myambutol)

what is a complication for all 4 antimycobacterial (TB) medications?

hepatotoxicity (toxic to the liver)

what is a complication of isoniazid?

peripheral neuropathy (numbness/tingling to fingers/toes)

what is a complication for rifampicin?

red discoloration of urine

what are antimycobacterial (TB) medications used for?

they are antituberculosis medications used for active TB

what is a nursing consideration of antimycobacterial (TB) meds?

monitor liver function

what is a way to remember TB meds?

R: Rifampicin

• red discoloration of urine

I: Isoniazid

• drug induced lupus, b6 deficiency, neuropathy

P: Pyrazinamide

• GI symptoms (puke)

E: Ethambutol

• optic loss (eyes)

the nurse working in the ER has multiple patients to care for. The first patient presents with sore throat and fever for 3 days. The nurse is instructed to administer amoxicillin 500mg. what should the nurse do?

a. instruct the patient to take the pill, drink a glass of water, then obtain a culture swab

b. instruct the patient to take the pill without water and then obtain the culture swab

c. obtain the culture swab and administer the amoxicillin with a glass of water

d. obtain the culture swab and instruct the patient to wait 2 days for the culture results before starting the medication

c. obtain the culture swab and administer the amoxicillin with a glass of water

what 2 systems are in the autonomic nervous system?

• sympathetic nervous system

• parasympathetic nervous system

what does the SNS do?

triggers fight or flight response

what does the PNS do?

triggers the rest and digest response

what does adrenergic mean?

adrenaline

what does alpha do?

constrict

what does an agonist do?

mimic

what does antagonist do?

blocks/inhibits

what does beta do?

dilate

what is muscarinic antagonist?

allows the SNS to dominate, creating similar effects as adrenergic, relaxing smooth muscle

T/F: muscarinic antagonists are anticholinergics?

True

what are the 4 muscarinic antagonist medications?

• atropine

• oxybutynin

• benztropine

• scopolamine

what does atropine do?

specific anticholinergic responses are dose related

what does oxybutynin do?

relaxes overactive bladder

what does benztropine do?

reduces tremors and muscle rigidity in parkinson’s disease/antipsychotic

what does scopolamine do?

used for motion sickness, and post-op n/v

what medication is a first generation antihistamine?

diphenhydramine (benadryl)

what medication is a second generation antihistamine?

cetirizine (zyrtec)

what does diphenhydramine (benadryl) do?

sedate

what does cetirizine (zyrtec) do?

non-sedating

what are decongestant medications? (3)

• ends in -rine

  • pseudoephedrine (sudafed)

  • ephedrine

  • phenylephrine (neo-synephrine)

what do decongestants do?

reduce nasal congestion in allergic rhinitis, sinusitis, and common cold

what is an adverse reaction for decongestants?

may not be suitable for those with diagnosis of hypertension

what is a beta-2 agonist (bronchodilators)

mimics lungs

what does a beta-2 agonist do?

stimulates our fight-or-flight response

what is SABA?

short acting beta agonist

what is a medication for SABA?

albuterol

rescue inhalers

what is LABA?

long acting beta agonist

what is a medication for LABA?

salmeterol

maintenance

what is patient teaching for beta-2 agonist?

always take beta-2 agonist before corticosteroid

why do you take beta-2 agonist before corticosteroids?

the lungs need to dilate first so the steroid has somewhere to go

what is nitroglycerin used for?

treatment of acute chest pain (angina)

how do you take nitroglycerin?

patients may take up to 3 sublingual tabs within 15 minutes (1 every 5 minutes) to relieve chest pain

what is a side effect of nitroglycerin?

headache

what is the therapeutic level of digoxin?

0.8-2 ng/mL

what level does toxicity occur when on digoxin?

greater than 2 ng/mL

what should be monitored with digoxin?

serum digoxin level

potassium

what is normal potassium levels?

3.5-5 mEq/L

what is an administration consideration for digoxin?

assess apical heart rate

what is patient teaching for digoxin?

monitor pulse rate and report <60 bpm

what are ACE inhibitor medications? (7)

• ends in -pril

  • lisinopril

  • captopril

  • enalapril

  • benazepril

  • fosinopril

  • ramipril

  • moexipril

what do ACE inhibitors do?

vasodilation and sodium/water excretion by blocking aldosterone

what is the black box warning for ACE inhibitors?

do not use while pregnant

what are the side effects of ACE inhibitors? (7)

• cough

  • persistent/dry

• angioedema

• anaphylactoid reactions

• neutropenia

• hyperkalemia

• hypotension

• proteinuria

What are Beta-1 Antagonists used for? (3 things)

• to treat hypertension

• chest pain due to poor blood flow to heart

• abnormal fast heart rate.

What happens when higher doses of Beta-1 Antagonists are given?

Higher doses can block Beta-2 receptors in the lungs causing bronchoconstriction.

What is an administration consideration for Beta-1 Antagonists?

Monitor blood sugar in diabetic patients because drug can mask symptoms of hypoglycemia

What adverse effect can happen with Beta-1 Antagonists?

Respiratory: Dyspnea and wheezing

What is Warfarin used for?

It is used to prevent additional clot formation. (does not break up the blood clot)

What labs should you monitor before administering warfarin?

PT & INR

What is the antidote for Warfarin?

Vitamin K

What medications should you take for ulcers? (5)

1. Antacid

2. H2 Blocker

3. PPI

4. Mucosal protectants

5. Antiflatulent

What medications should you avoid for ulcers? (2)

1. Aspirin

2. NSAID’s

What are PPI’s used for?

lower stomachs acidity

What can happen if you take PPI’s long-term?

hypomagnesium

What teaching and education should you give your patient in regards to PPI’s?

call provider if bleeding occurs

What are mucosal protectants used for?

Treatment of ulcers

What is an administration consideration given to your patient about mucosal protectants?

• take on an empty stomach

• 2 hrs after or 1 hr before meals

• bedtime

What does type 1 diabetes do to your body?

causes an autoimmune reaction (body attacks itself by mistake)

What does type 2 do to your body?

• cells don’t respond normally to insulin

• aka, insulin resistance

Which diabetes type is treated with insulin for life?

Type 1

Can you take oral medications to treat type 1 diabetes?

NO

What treatments can be used for type 2 diabetes?

• oral medications

• insulin

What is gestational diabetes?

Diabetes that is developed during pregnancy

What is Diabetic Ketoacidosis (DKA)?

life-threatening complications of diabetes that causes increased blood glucose