FINAL EXAM - Pharmacology NR 293 Questions and answers + rationales

Transdermal Scopolamine administration

Anti-nausea patch placed behind ear at least 4 hours prior and worn for 3 days max

Adrenergic Agonists

Drugs that stimulate and mimic the actions of the sympathetic nervous system (fight or flight); increase BP, HR, dilates airways, increases pupil size

Corticosteroids averse effects

Hyperglycemia, thinning of the skin, increased risk of infection, edema, HTN, osteoporosis

Ondansetron (Zofran) adverse effects

Headache, diarrhea, dizziness, prolonged QT interval, cardiac dysrhythmias

ACE inhibitors adverse effects

Angioedema, dry cough, hyperkalemia

Alosetron (Lotronex) adverse effects

Constipation, which can result in impaction, perforation, obstruction

CAI adverse effects

Disturbances in Acid/Base and electrolyte balances, metabolic acidosis, hypokalemia; increased blood sugar in diabetics

Dabigatran (Pradaxa) adverse effects

GI upset and bleeding

Fibric Acid Derivatives adverse effects

Abdominal discomfort, diarrhea, nausea

Blurred vision, headache

Increased risk of gallstones

Prolonged prothrombin time

Liver studies may show increased enzyme levels

Older adults taking hypertensive medications need to be educated about:

Orthostatic hypotension

Isotretinoin adverse effects

Suicidal ideation, bone pain, birth defects in pregnant women

Milirinone adverse effects

Cardiac dysrhythmia, hypotension, angina, hypokalemia

Orlistat (Xenical) adverse effects

Hepatotoxicity, increased defecation

Somatropin adverse effects

Edema, hyperglycemia, pancreatitis

Overuse of adrenergic nasal decongestants may cause:

Rebound congestion, dependence

Patients using topical tretinoin should be educated regarding:

Photosensitivity - wear suncreen

Amiodarone MOA and use

Decreased action potential and prolonged QRS duration; used for ventricular, supra-ventricular dysrhythmia

Anticholinergic drugs effect the:

Parasympathetic nervous system

Anticoagulant interactions

Gingko, garlic, ginseng, ginger all increase bleeding risk

Heparin antidote

Protamine

Warfarin antidote

Vitamin K

Antihypertensives may cause what in males

Erectile dysfunction (ED)

Isoniazid

Antitubercular drug that decreases visual acuity (peripheral neuropathy)

Ribavirin (Virazole)

Antiviral that interferes with RNA/DNA synthesis which inhibit protein synthesis + viral replication; used to treat RSV in children

Dexmedetomidine (Precedex) administration and uses

By IV continuous for no more than 24 hours; must be titrated on/off to prevent CV rebound; used for sedation/analgesia for mechanically ventilated patients in the ICU

Antifungal used to treat Aspergillosis

Caspofungin (Cancidas)

Basal dosing of insulin

Administration of a long-acting insulin to keep the blood glucose from fluctuating; mimics the natural action of the pancreas

DM patients taking beta blockers may experience what adverse effects

Mask low blood glucose

Cardiovascular effects of low-dose cholinergics

Bradycardia and vasodilation

Metoprolol cardiovascular effects

Slows HR, decreases BP. Administered to MI patients to promote blood circulation

Primary hypothyroidism causes

Congenital defects or loss following treatment, or defective synthesis resulting from autoimmune disease

Cimetidine taken off market for

Carcinogenic concerns

5th generation cephalosporins

Ceftaroline; novel broad-spectrum antibiotic used against gram positive infections

Levothyroxine drug interactions

Warfarin, cholesterol medications, PPI, antacids

Classic angina

Occurs with predictable stress or exertion; goes away with rest

Older adults taking vasodilators may experience:

Heart palpations, increased heart rate, fluid retention

Mannitol nursing considerations

-Monitor daily weight, I&O, and serum electrolytes

-Monitor for signs of dehydration, acute kidney injury, and edema

Enoxaparin (Lovenox) contraindications

Active bleeding, hemorrhagic CVA, heparin-induced thrombocytopenia, gastric or duodenal ulcers

Cyclosporine and allopurinol

Allopurinol can increase cyclosporine levels (dizziness, numbness, skin tinging, muscle twitching, seizures)

Dabigatran and afib

Lowers the risk of thrombotic events during nonvalvular afib

Oxybutynin (Ditropan)

Used to treat overactive bladder; contraindicated in urinary retention, open-angle glaucoma, intestinal obstruction

Nitrofurantoin (Macrodantin)

Multigenerational antibiotic; contraindicated in renal disease, near-term pregnancy

Interferon dose limiting adverse effect

Extreme fatigue

Antilipemic drug/food interactions

Statin drugs, oral anticoagulants, erythromycin, antifungals, grapefruit juice

Desmopressin drug interactions

Loop diuretics and systemic glucocorticoids increase risk of hyponatremia

Kava (herbal)

Used to treat restlessness, anxiety; has calming.euphoric effect

Hemoglobin (Hgb)

• Females 12-16 g/dL

• Males 14-18 g/dL

Tyramine foods

Aged meats and cheeses, fermented products, kimchi, soy, sauerkraut

Gentamicin interactions

Ototoxic drugs

Nephrotoxic drugs

Hemoglobin A1c prediabetic levels

5.7-6.5%

Dabigatran (Pradaxa) patient education

Inform provider of black/tarry stools, pink/brown urine, coughing or vomiting blood

Amino-glycoside (amikacin, gentamicin, tobramycin) toxicity

Nephrotoxicity (proteinuria, increased BUN, increased creatinine)

Indomethacin MOA and uses

Inhibits the synthesis of prostglandins; indicated for inflammatory disorders (rheumatic arthritis, gout)

INR (mechanical valve)

25-35

SSRI interactions

Increased CNS effects with alcohol and other CNS depressants; increased bleeding risk with NSAID, aspirin, warfarin

Diuretic used to treat hypertension

Thiazides (they inhibit Na, Cl, K resorption)

Irinotecan can cause

Severe diarrhea; toxicity occurs within 24 hours of administration

Mannitol reduces

intraocular pressure

intracranial pressure

risk of renal failure

Heparin lab testing

aPTT (activated partial thromboplastin time); measures how long it takes for a blood clot to form

Lab monitoring for cardiac glycosides

Digoxin; monitor serum electrolytes (potassium, magnesium, calcium)

Leucovorin rescue

Can block/reduce Methotrexate = ↑ folic acid via a reduced folate

Lithium and Desmopressin

Lithium diminishes the antidiuretic response to desmopressin = decreased effectiveness

Nadir

Lowest point; in chemotherapy treatment, this is the lowest the blood cell counts will be

Gabapentin use

Peripheral neuropathy

Persistent diarrhea treatment

Anticholinergics + opiates

Loop diuretics MOA and onset of action

Block chloride + sodium resorption; onset 5 minutes by IV + 30 minutes PO

Beta1-adrenergic receptors

Relax muscles of the airway = widening + easier breathing

Nesiritide (Natrecor) MOA

Vasodilation via increased cGMP; relaxes and dilates blood vessels in CHF patients

Ezetimibe (Zetia) MOA

Inhibits intestinal cholesterol absorption to reduce LDL

Vancomycin treats

MRSA, C-diff, gram (+)

Nitroprusside infusion time

10 minutes MAX; used in hypertensive crises

Doxazosin (Cardura) patient teaching

Antihypertensive should be taken at the same time each day; may cause dizziness, drowsiness, orthostatic hypotension

Saw Palmetto is used to treat

Benign prostatic hyperplasia

Nicotinic Acid (Niacin)

Vitamin B3; Used in combo with a statin or bile acid-binding agent to lower LDLs

Prilosec (omeprazole)

PPI used to help acid indigestion (GERD); treats the symptom not the cause

IV vancomycin

Infused over at least 60 minutes; rapid infusion can cause severe hypotension, red man syndrome

Quinolones adverse effects

Tendonitis and tendon rupture

Rapid-acting insulin

Lispro, aspart, glulisine; should be administered within 15 minutes of food

CIDOFOVIR + Probenecid

Cidofovir antiviral that has extreme nephrotoxic abilities; probenecid is a renal protectant administered concurrently

Lactulose in liver failure

Reduction of ammonia levels; increased mental alertness

Retrovir

Antiviral given at 14 weeks gestation throughout pregnancy for HIV prevention

Digoxin toxicity

Headache, dizziness, visual disturbances, halo's green or yellow in color

Medroxyprogesterone treats

Secondary amenorrhea

Single-dose drug for vaginal yeast infection

Fluconazole

Steroids + diabetic patients are at risk for

Hyperglycemia

Organophosphate insecticide poisoning is treated by

Atropine

Oral contraceptive that duplicates women's normal hormone levels

Triphasic oral contraceptive; secretes various amounts of progestin + estrogen

Santyl (Collagenase) is used for

Debridement of wounds

Chemotherapy premeds

Administered to prevent allergic reactions; consists of antihistamine, corticosteroid, H2 receptor agonist

Voriconazole adverse effects

Triazole anti-fungal medication that may cause hallucinations, tachycardia, abnormal vision

Adenosine (IV)

Short hear block or a-systole is expected

Warfarin Patient Education

•Eat a balanced diet.

•Do not eat large amounts of leafy, green vegetables. Leafy, green vegetables contain vitamin K. Too much vitamin K can lower the effect of warfarin.

•Regular INR checks.

•Avoid activity or sport that may cause a serious injury.

•Pregnant patient should not handle crushed or broken warfarin tablets.

•Call provider in the event of a fall.

Calcium Channel Blockers and angina

Block Ca channels in vascular smooth muscle, dilate coronary & peripheral arteries, decrease myocardial contractility = decreased angina