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Week 14 Pharmacology Review – Comprehensive Study Notes

Insulin: Types, Timing, & NCLEX-Style Matching

  • Lispro (Humalog)
    • Rapid-acting; administer 15\text{ min} before meals for post-prandial coverage.
  • Regular insulin (not explicitly named in transcript but part of drug family)
    • Short-acting; given 30!–!60\text{ min} before meals.
  • NPH
    • Intermediate-acting; cloudy suspension; typically dosed BID (breakfast & supper).
  • Glargine (Lantus)
    • Long-acting/basal; \approx 24\text{ h} duration; once-daily, same time each day.
  • Exam tip ➜ Rapid, Short, Intermediate, Long = “L R N G” alphabetically mirrors speed (Lispro fastest, Glargine slowest).

GI / Antiemetics & Weight Loss

  • Ondansetron
    • 5-HT_3 antagonist; 1st-line for chemotherapy-induced nausea & vomiting.
    • Adverse: QT-prolongation → obtain/monitor EKG, caution in dysrhythmia risk.
  • Orlistat
    • Lipase inhibitor for weight management; causes steatorrhea (“oily stools”) & fecal urgency.
  • Test-taking pearl: Four key-term drugs start with “O” (ondansetron, orlistat, oxytocin, omeprazole) → read entire word, not just first letter.

Obstetric / Women’s Health

  • Oxytocin
    • Induces or augments labor (41-week gestation scenario).
    • Monitor fetal heart rate & uterine tone (tachysystole risk).
  • Betamethasone
    • Corticosteroid for fetal lung maturity in preterm (<37\text{ wk}) labor.
  • Magnesium sulfate
    • Tocolytic to delay preterm contractions; also seizure prophylaxis in eclampsia; monitor DTR, RR, serum Mg; toxicity → muscle weakness.
  • Clomiphene
    • Induces ovulation in infertility; ↑ multiple gestations (twins/triplets).
  • Misoprostol
    • Prostaglandin analog; cervical ripening, labor induction, PUD prophylaxis, but risk of uterine contractions.

Thyroid Pharmacology

  • Propylthiouracil (PTU)
    • Blocks thyroid hormone synthesis; used in hyperthyroidism/Graves.
    • Monitoring:
    – TSH to titrate dose (ensure euthyroid).
    – WBC count for agranulocytosis (infection risk).
    • Black-box: severe hepatotoxicity (check LFTs, though not option in question).

Antidote Highlight: Acetylcysteine

  • Acetaminophen overdose → ↑ LFTs, hepatic necrosis; give acetylcysteine (replenishes glutathione).
  • Other uses:
    • Nephro-protection before IV contrast.
    • Mucolytic in cystic fibrosis/bronchitis (nebulized).
  • Differential drugs in vignette:
    • Albuterol β2-agonist rescue inhaler (tachycardia/tremor). • Phenylephrine α1 agonist nasal spray (limit 3–5 days → rebound congestion).
    • Diphenhydramine 1st-gen antihistamine (sedation).

Magnesium Sulfate: Indications & ADRs (Select-all-that-apply question)

  • Therapeutic indications:
    1. Preterm labor (tocolysis)
    2. Severe asthma exacerbation (smooth-muscle relaxant)
    3. Dysrhythmias (torsades de pointes)
  • NOT used for hypotension; high dose causes muscle weakness → sign of toxicity.

Hematology / Oncology Support

  • Filgrastim (G-CSF)
    • Stimulates neutrophil production; given for chemotherapy-induced neutropenia or baseline low WBC.
  • Alteplase (tPA)
    • Fibrinolytic; dissolves existing clots in ischemic stroke, MI, occluded central line/catheter.
    • Contraindicated ⇢ active bleed, recent surgery, severe HTN.

Dermatology & Hormonal Agents

  • Combination oral contraceptives (estrogen + progestin)
    • Reduce cystic acne, treat dysmenorrhea, endometriosis, cycle regulation.
    • Also protect vs osteoporosis.
    • Contra: smoker >35\text{ yr}, estrogen-dependent cancers, clot history.
  • Finasteride
    • 5-α-reductase inhibitor; BPH, androgenic alopecia; ↓ PSA; teratogenic to male fetus.
  • Testosterone increases acne; not treatment.

Eye / ENT Preparations

  • Latanoprost
    • PGF_{2\alpha} analog; ↑ outflow of aqueous humor → ↓ IOP in open-angle glaucoma; can darken iris, ↑ eyelash growth.
  • Beclomethasone (inhaler)
    • Rinse mouth post-use to prevent oral candidiasis (thrush) if used in asthma.
  • Ciprofloxacin + dexamethasone ear drops for otitis externa (swimmer’s ear).

Anticoagulation & Antiplatelet Monitoring

  • Heparin
    • aPTT monitoring (1.5!–!2.5\times control).
    • Protamine sulfate antidote.
  • Warfarin
    • Monitor INR (goal 2!–!3).
    • Vitamin K antidote; many drug/food interactions.
  • Clopidogrel
    • ADP-receptor antiplatelet; prevents stent thrombosis & secondary MI; bleeding risk shared with heparin & warfarin.

Neuro-Critical Care

  • Mannitol
    • Osmotic diuretic; lowers intracranial & intraocular pressure.
    • Monitor: serum K^+, Na^+, renal function, EKG.

Erectile Dysfunction Agents

  • Sildenafil / Tadalafil / Vardenafil
    • PDE-5 inhibitors; vasodilate corpus cavernosum.
    • Contra: concurrent nitrates (nitroglycerin) → severe hypotension.
    • Avoid grapefruit juice (CYP metabolized).
    • Onset minutes; do NOT take 4 weeks for effect.

Cardiac Glycoside Toxicity

  • Digoxin
    • S/S: visual halos, nausea/vomiting, arrhythmias; check level (0.5!–!2\,\text{ng/mL}) & K^+.
    • Other drugs:
    – Atorvastatin → myopathy.
    – Nitroglycerin → dizziness, headache (vasodilation).
    – Ramipril (ACE-I) → dry cough, angioedema, hyperkalemia.

Peptic Ulcer Disease – “Triple Therapy” for H. pylori

  • Standard regimen 14\text{ days}:
    • Omeprazole (PPI)
    • Amoxicillin
    • Clarithromycin
  • Alternatives:
    • Metronidazole if PCN-allergic.
    • Metoclopramide not part of triple therapy; risk extrapyramidal/Parkinson-like effects.
    • Sucralfate coats ulcer base; separate from antacids & other meds by 2\text{ h}.

Benign Prostatic Hyperplasia

  • Tamsulosin (α_1 blocker)
    • Relaxes bladder neck/prostate → improved urine flow.
    • Adverse: orthostatic hypotension, first-dose syncope, dizziness upon standing.
  • Finasteride shrinks prostate (5-α-reductase).
  • Terbutaline (β_2 agonist) now asthma-only; previously tocolytic.

Drugs Affecting Heart Rate

  • ↓ HR drugs:
    • Diltiazem, Verapamil (non-DHP CCB).
    • Metoprolol (β_1-blocker).
  • Does NOT ↓ HR:
    • “Cholecystectomy” listed as distractor—actually surgery to remove gallbladder; causes ↓ absorption of fat-soluble vitamins A, D, E, K.

Diuretics & Electrolyte Changes

  • Spironolactone
    • K^+-sparing; risk hyperkalemia; also anti-androgen (gynecomastia).
  • Furosemide (loop)
    • Causes hypokalemia, ototoxicity (tinnitus), hypocalcemia; watch sulfa allergy cross-reactivity.
  • Hydrochlorothiazide (HCTZ)
    • Hypokalemia; ↑ uric acid (avoid in gout); sulfa cross allergy.
  • Sodium Bicarbonate
    • Treats metabolic acidosis & hyperkalemia by shifting K^+ intracellularly.

Endocrine – Hypoglycemia Risk & Others

  • Glipizide (sulfonylurea)
    • Stimulates insulin regardless of serum glucose → hypoglycemia risk; avoid in sulfa allergy.
  • Metformin
    • ↓ hepatic gluconeogenesis; GI upset common; rare lactic acidosis (hold in CT contrast 48\text{ h}).
  • Prednisone
    • Glucocorticoid; ↑ glucose, ↓ immunity, long-term osteoporosis, Cushingoid features.
  • Levothyroxine
    • For hypothyroidism; excess dose → tachycardia, tremor, heat intolerance (hyperthyroid signs) ⇢ lower dose.

Benzodiazepine for Alcohol Withdrawal

  • Diazepam
    • Long-acting BZD; prevents seizures & delirium tremens in ETOH withdrawal; monitor RR, sedation; antidote flumazenil (rarely used in chronic users ‑ risk seizures).

Exam / Test-Taking Nuggets

  • Week 14 content appears only on comprehensive final, not unit test.
  • Matching, select-all-that-apply, & look-alike drug names are common formats.
  • Always read the whole drug name (ondansetron vs oxytocin vs orlistat vs omeprazole).
  • Monitor for shared adverse effect themes:
    • ↑ Bleeding: heparin, warfarin, clopidogrel, alteplase.
    • QT prolongation: ondansetron.
    • Hyperkalemia: spironolactone, ACE-I, ARBs.
    • Orthostatic hypotension: α-blockers (tamsulosin).
    • Pregnancy: teratogens (finasteride, misoprostol use caution), category X (statins, isotretinoin not in transcript).

Quick Reference – Lab Monitoring Cheat Sheet

  • Heparin → aPTT.
  • Warfarin → INR.
  • Digoxin → serum dig level 0.5!–!2.
  • PTU → TSH, WBC, LFTs.
  • Mannitol & diuretics → electrolytes (K^+) & EKG.