Exam 4 V1: NUR 210/ NUR210– Principles of Pharmacology Guide | Galen (Latest 2026/ 2027 Update) 100% Verified Questions & Answers | Grade A

Exam 4 V1: NUR 210/ NUR210– Principles of Pharmacology Guide | Galen (Latest 2026/ 2027 Update) 100% Verified Questions & Answers | Grade A Q: What are three lab tests we run for chest pain? Answer Creatine Kinase, Troponin, Myoglobin Q: What are the details about Creatine Kinase? Answer It's specific to myocardial cells, because if myocardial cells are damaged, CK is released. This number peaks in 15-20 hours after incident. Q: What about Troponin? Answer Levels rise more quickly, and is more specific to heart damage than CK. Peaks in same amount of time. Q: What about Myoglobin test? Answer Rises very quickly after MI, and is cleared in one day. IT can only be measured within 12 of hours of MI Q: Cardiac Natriuretic Peptide Markers Answer When the value is elevated, then the heart is being overworked. The uretic is given so kidneys will pee out fluid and relieve stress on the heart. Q: Difference between HDL, LDL, and triglycerides? Answer HDL is considered the good, LDL the bad, and Tri is the ugly. HDL should be higher to protect the body Q: Define these four ECG's Answer Telemetry, 12 lead, holter, and stress Telemetry keeps a track of the electrical activity of the heart 12 lead is twelve different electrodes across the body to get all the best angles of the heart function Holter is remote tracing that people wear for a few days to look for correlation between activity and heart rate Tress test is where you put a 12 lead on someone and have them walk. Q: What is an ECHO and how do you read it? Transesophageal? Answer You read it upside down and backwards (LV is upper right). This helps us see how the left ventricle is working because it has the most amount of push and work in the heart. We sedate patients and put a tube down the esophagus to help get a clearer picture Q: What is an angiogram and where do you do it from? Answer This is the most evasive way to view the heart. You do it femorally or radially, and it helps us check for blockages and/or heart disease. We inject die into vascular part of the heart. Q: Numbers for prehypertension and stage 1 hypertension Answer Pre: 120-139 or 80-89 Stage 1: greater than 139 or 89 Q: Difference between systole and diastole Answer Systole is the heart squeezing and pumping from the artery Diastole is when the heart is at rest and filling up Q: Numbers for stage 2 hypertension Answer Over 160 and 100 Q: Why was primary hypertension once called essential hypertension? Answer Because it was providing the adequate amount of perfusion Q: What are contributing factors to primary hypertension? Answer Age Hyperactive SNS Hyperactive renin-angiotensin system (kidneys are working overtime and sodium is being reabsorbed) Endothelial dysfunction (inner lining artery damage, making it more difficult to expand and contract) Q: What is secondary hypertension? Answer Hypertension with an identifiable cause Q: Secondary Hypertension causes? Answer Renal disease, coronary artery disease, pregnancy, drug therapy, sleep apnea Q: Long term effects of hypertension Answer MI, heart failure, kidney disease, stroke, PAD, retinopathy Q: What is cardiac output and the normal cardiac output? Answer The amount of blood pumped OUT of the heart every minute. This number is 4 L a minute on average. Q: What is ejection fraction and how do you find it and what is the normal? Answer The amount (%) of blood getting pumped each time a heart beats. You can find this number from an ECHO. The normal percentage is 50-80%. Q: What is cardiac index? Answer Same as cardiac output, except the size of the body is included. Which happens longer, systole or diastole? Answer Diastole is double the time of systole, you want to rest twice as long as you work. When your heart rate increases does it effect systole or diastole? Answer It only effects diastole. If you double your heart rate you're cutting the amount of rest time in half. What is venous return? Answer How well the blood flows back after the body had it What is peripheral resistance? Answer How tight/small your arteries are. This can be effected by clots, fats, and SNS. When you combine this with your cardiac output, you get your blood pressure. Contractility Answer Strength of cardiac cells to contract/shorten Preload Answer Amount the ventricles stretch at the end of diastole. What's going on during diastole? It's relaxing/filling of the ventricles with blood. Preload is once the ventricles have filled Preload is the end-diastolic volume. How to increase/decrease preload Answer Increase: administeration with IV solution, which increases blood return to the heart, which increases the amount of blood in end of diastole (inc preload) We can also stimulate the SNS, which vasoconstricts, which increases venous return to end of diastole (inc preload) Decrease Preload Answer Do it with fluid overload Administer diuretics: Answer Removes fluid from blood from the kidney filtration, will decrease amount of venous blood return (dec preload) Vasodilation: Dilation/widen of blood vessels, which will decrease amount of venous return (dec preload) Afterload Answer Pressure the ventricles must work against, to open the semilunar valves, so blood can leave the ventricle and go to the lungs or body. Its mainly affected by vascular resistance. Pressure of aorta is keeping valve closed. Ventricle must overcome the vascular resistance (afterload) Increase afterload Answer When you have vasoconstriction (narrowing), it increases the pressure that the ventricles must overcome. Pulmonary hypertension Valve problems can increase afterload too. It can affect the outflow of blood, and increase pressure of the ventricle. Decrease afterload Drugs Vasodilation: decreases vascular resistance, which decreases pressure the ventricle must work against, decreasing afterload Why is afterload importand? Because the amount of pressure the heart has to come up with to push the blood out, uses up more oxygen in the cardiac cycle. This can cause chest pain when there is a lack of oxygen. What can affect preload? Heart rate (faster the heart, less time to fill. Blood pressure increases when Cardiac output increases and peripheral vascular resistance increases What changes can you make to reduce hypertension? Weight loss, exercise, stress reduction, smoking, alcohol, caffeine, cholesterol (DASH diet) Effect on preload or afterload Slide 20 What do beta blockers (-olol) do? Blocks the beta receptors in the heart which causes a decrease in heart rate, conduction system, and force of contraction. Decreasing your heart rate will allow for a longer diastole and more time to fill, allowing for a better squeeze ADR's of beta blockers Too much of a good thing...hypotension, bradycardia, bronchial constriction, drowsniness What are diuretics? Works on preload (gets rid of water). Promote renal excretion of water and lytes, which increases urinary output. Helps remove edama fluid and hypertension. How do diuretics work? They all work the same way. They block NaCl from reabsorbing, which whill cause water to stay with it, allowing you to urinate it ADR's of diuretics Hypovolemia and electrolyte balance What is a thiazide diuretic? First choice of diuretic. It only does a 10 percent increase so it shouldn't work too well. It works on the distal convoluted tubule. It reduces amount of blood volume, which reduces the arterial resistance. All end with (iazide) ADR's of thiazide Hypokalemia, inhibits insulin from working (hyperglycemia), increases uric acid (hyperuricemia), and causes gout. What are high-ceiling loop diuretics These work the best (20%) and work in the ascending loop of Henle. Moves a lot quicker and makes more pee. ADR's are the same except ototoxicity what are Potassium-sparing diuretics They block aldosterone in the nephron, and is a potassium retention. Weaker diuretic (2%) ADR's: Hyperkalemia Avoid with ACE's and ARBs since they also promote hyperkalemia Slide 32 What are ACE inhibitors? They all end in 'pril' They interrupts RAAS to make the arteries no longer constrict, and aldosterone does not save the sodium. ADRs for ACE inhibitors Stay with patient for first dose given. Keep an eye on blood pressure. Persistent cough (inc bradykinin) Hyperkalemia (potassium retention) Angioedema: Life threatening edema in the neck causing blockage in upper airway What are Angiotensin 2 receptor blockers (ARBS) Slide 34 Order of electrical currency through the heart Starts in SA node, atrial depolarization, pushes more blood through the valves, which is 20 percent of cardiac output...?? Minute 15 of video What is cardiac glycoside (digoxin/lanoxin)? It slows the transmission of cardiac impulses through the cardiac conduction system, and increases the force of cardiac contraction. It allows more time for the heart to squeeze, which helps for more output from the heart. Smaller the heart rate, the less of the squeeze time (inc diastole) ADRs of cardiac glycosides Since there is a low TI, toxicity is a real possibility. Nausea, anorexic, and bradycardic as well. Digoxin and potassium levels are measured from the same Slide 43 What is angina pectoris and the different types? Chest pain when there is a lack of oxygen to the heart, usually occurs in men. Chronic: People who have CAD, and they exert themselves they get chest pain Variant: Happens anytime Unstable: emergency What are nitrates? increases the blood flow to the coronary arteries but dilates all the arteries. Incredibly lipid soluble, and 5-7 minute half-life. ADR's are hypotension and headaches. Never take more than 3. Nitrates routes of administration? Sublingual: don't swallow, if pain isn't relieved you can take a second within 5 mins, only 3 though. Topical: rotate sites and remove previous patch Oral: Sustained release IV: only for emergencies. Different types of immobility Temporary (pregnancy) Permanent: strokes, joints, amputation Acute: broken bones Chronic How does immobility affect the respiratory system? Limited chest expansion (against gravity), decrease cough response to get mucus up, which is stasis of pulmonary secretions. Laying down can also cause trouble for breath sounds, because fluid will move to the posterior part of the lung, making breath sounds clear anteriorly. How does immobility affect the cardiovascular system? Stasis of blood in the legs from lack of movement, which can cause DVT and clot formation. Calcium will leave bones and go in blood, inc chance of thrombus. Cardiac workload inc because heart works harder to rotate blood through the body. How does immobility affect the genitourinary system? Stasis of urine in kidney and bladder, increasing risk of infection. Renal calculi formation because calcium leaves the bones. Increased UTI's because foley catheters and keeping the urine in. how does Immobility affect the gastrointestinal system? Decreased intestinal mobility, increased constipation and fecal impaction. Gastric stress ulcers because acid will start to work on the stomach instead of food. How does immobility affect the integumentary system? Dec ciruclation and sensation to peripheral areas. Constant pressure on bony prominences will cause a decreased sensation and blood supply to the area. Shearing forces (slide up and down) How does immobility affect the musculoskeletal system? Osteoporosis from calcium loss and no weight bearing. This causes PATHOLOGIC FRACTURES where the only reason it's fractured is from lack of bone mass. Muscle atrophy, feet drop, joint contractures, decreased endurance, and altered calcium metabolism (so much calcium in blood, doesn't take it from food anymore) How does immobility affect nutritional alterations? Metabolic rate drops, anorexia (forget they need food), tube feeds, negative (higher) nitrogen balance because muscles break down, which breaks down proteins, which contains nitrogen. Types of viruses Flu Herpes Hepatitis A, B, & C Most antivirals and antibiotics have what SE GI distress Anti-viral Acyclovir Acyclovir use to prevent replication for herpes virus Acyclovir SE crystalluria caution w/ electrolyte disorder Acyclovir caution nephrotoxicity seizure disorder Acyclovir teaching increase fluid intake get up slowly (orthostatic htn) Anti-fungal (local) Nystatin Nystatin (topical) use athlete's foot Nystatin (oral) use oral candidiasis (thrush) vaginal candidiasis (yeast infection) superficial fungal infections oral candidiasis (thrush) vaginal candidiasis (yeast infection) tinea pedis (athletes foot) systemic fungal infections Lungs CNS abdomen Opportunistic fungal infections immunocompromised patient superinfection steroids chemotherapy Anti-fungal (systemic) fluconazole fluconazole route Oral, IV, vaginal, topical fluconazole use -systemic fungal infections -immunosuppressed pts to prevent yeast infection fluconazole nursing interventions -culture PRIOR to medication - monitor LFTs Urinary antiseptic Nitrofurantoin Nitrofurantoin use acute and chronic UTIs Nitrofurantoin teaching -Notify MD if there are signs of superinfection -rinse mouth (stains teeth) -urine turns rust/brown Nitrofurantoin SE turns urine rust/brown Urinary analgesic Phenazopyridine Phenazopyridine use does not get rid of infection relieves symptoms Phenazopyridine SE red-orange urine and secretions inherent resistance Ability of the host to resist the disease independent of antibodies acquired resistance bacterial resistance to a drug to which they were previously taking for long periods of time When should C & S be done? prior to starting antibiotic Macrolide antibiotic Azithromycin Antacid administration with macrolides 2 hr before or after macrolide dose Azithromycin use -STI -Chlamydia -when pts are allergic to PCN/cephalosporins for stronger bacterial infections Azithromycin SE blurred vision headache drowsiness fatigue photosensitivity Azithromycin ADR Superinfection tinnitus hepatotoxicity (liver) Azithromycin contraindications hepatic/renal dysfunction heart issues TYLENOL Azithromycin nursing interventions monitor for liver enzymes & for s/s of liver issues Glycopeptide antibiotic Vancomycin Vancomycin use MRSA serious infections Vancomycin IV caution give slowly to prevent redman syndrome Vancomycin SE chills dizziness GI distress Thrombophlebitis (central IV) Vancomycin ADR nephrotoxic ototoxic redman syndrome redman syndrome SE rash to face, neck, back and chest htn tachycardia wheezing sometimes itching Vancomycin nursing interventions peak & trough hearing test renal test Tetracycline antibiotic Doxycycline Doxycycline use infections acne Doxycycline SE stomatitis GI distress photosensitivity discoloration of permanent teeth Doxycycline ADR superinfection hepatoxicity sjs Doxycycline contraindications decreases effects of oral contraceptives children under 8 pregnant women Doxycycline teaching -use another form of birth control -avoid milk, iron, antacids Aminoglycoside antibiotic Gentamicin Gentamicin use serious infections Gentamicin SE ototoxicity superinfection nephrotoxicity Gentamicin nursing interventions peak and trough baseline hearing test Sulfonamides antibiotic trimethoprim/sulfamethoxazole Trimethoprim-sulfamethoxazole use both drugs together cause bacteria resistance to develop much more slowly -uti -mrsa -alternative to penicillin Trimethoprim-sulfamethoxazole SE photosensitivity Trimethoprim-sulfamethoxazole ADR hypoglycemia crystalluria Trimethoprim-sulfamethoxazole caution diabetes Trimethoprim-sulfamethoxazole teaching sun precautions Trimethoprim-sulfamethoxazole topical use burns sometimes skin ulcers Amoxicillin SE tongue discoloration stomatitis glossitis Amoxicillin contraindications allergy to other PCN or cephalosporins decrease effect with acidic fruits/juices Penicillin antibiotic Amoxicillin Amoxicillin use bacterial infections Amoxicillin ADR C. diff associated diarrhea Fluoroquinolones antibiotics Ciprofloxacin Levofloxacin Ciprofloxacin & Levofloxacin use severe infections Ciprofloxacin & Levofloxacin ADR SJS tendon rupture nephrotoxicity hepatotoxicity Antibiotics Metronidazole Cephalosporins Amoxicillin Azithromycin Vancomycin Doxycycline Gentamicin Ciprofloxacin Levofloxacin Trimethoprim-sulfamethoxazole Metronidazole teaching NO alcohol reaction: facial flushing, sweating, severe HA, slurred speech Metronidazole use GI (H. Pylori) GU (STIs) Metronidazole SE Superinfection-(C.diff / thrush) dark urine metallic/bitter taste GI distress Cephalosporins use bacterial infections Cephalosporins SE GI upset dizziness/ vertigo headache Cephalosporins ADR superinfection nephrotoxicity Cephalosporins teaching Report symptoms ADR of yeast infection no citric juices Cephalosporins administration IV over 30 mins IM mixed w/ solution Gastrointestinal antiemetics promethazine ondansetron metoclopramide promethazine SE dizziness (anticholinergic) DRYYYY promethazine ADR EPS respiratory distress ondansetron SE headache dizziness metoclopramide MOA increases GI emptying metoclopramide use POST OP helps with peristalsis metoclopramide SE high doses can cause sedation & diarrhea Gastrointestinal antidiarrheal diphenoxylate with atropine diphenoxylate with atropine use diarrhea diphenoxylate with atropine MOA slows gastric motility diphenoxylate with atropine caution paralytic ileus with long term use monitor bowel sounds Gastrointestinal laxative Bisacodyl Bisacodyl use constipation Bisacodyl ADR dependence hypokalemia Bisacodyl contraindiciations if you have an electrolyte imbalance DO NOT GIVE Bisacodyl nursing interventions use only as needed with water Metabolic acidosis pooping "pooping out your ass" Metabolic alkalosis vomiting Antiulcers antacid famotidine pantoprazole sucralfate Antacid Magnesium (Mg) hydroxide/aluminum hydroxide Famotidine (Pepcid) use treat peptic ulcers & GERD Famotidine (Pepcid) MOA reduce gastric acid Famotidine (Pepcid) contraindications tale 30 mins before any other drugs Pantoprazole MOA reduce gastric acid Pantoprazole contraindication Take 30 mins before any other drug sucralfate MOA coats the ulcer Sucralfate contraindications take 1-2 hours before any other drug Erythropoietin stimulating agent epoetin alpha epoetin alpha SE injection site reaction epoetin alpha BB warning if hemoglobin over 11: hx MI, stroke, patient with cancer, increased risk of embolism have an increased risk of death with this drug epoetin alpha use treats anemia epoetin alpha MOA produces RBC Granulocyte colony stimulating factor filgrastim filgrastim MOA increases WBC to help prevent infection Male hormone testosterone testosterone use hypogonadism - delayed puberty Sexual dysfunction sildenafil sildenafil MOA increases blood flow to penis sildenafil use erectile dysfunction sildenafil caution do not take nitroglycerin within 24 hrs of this drug Benign prostatic hyperplasia (BPH) Tamsulosin Tamsulosin MOA Relaxes muscles in prostate Tamsulosin use Improves symptoms associated with BPH Tamsulosin ADR orthostatic hypotension Tamsulosin therapeutic symptoms not dribbling increased urine flow Menopause (HRT) conjugated estrogen HRT: conjugated estrogen (test answer) Test answer: Taking these hormones are going to increase your risk for breast cancer & endometrial cancer HRT: conjugated estrogen use minimize menopause symptoms Osteoporosis (oral bisphosphonate) alendronate alendronate use Prevention and treatment of osteoporosis very long half life! alendronate teaching -Take on empty stomach with 8 ounces of water and sit upright for 30 minutes -Wait 30 minutes after ingestion to eat, drink or take other medications