NURSING PHARMACOLOGY pharm Final Exam part 1 Exam (elaborations)

NURSING PHARMACOLOGY pharm Final Exam part 1 Exam (elaborations) Aid to Success Final Exam part 1 Spring 2020 REMEMBER: review the key points and summary of major nursing implications. What types of patients use an inhaled short acting beta 2 agonist? Asthma patients What are examples of bronchodilators? Which one are common? Which ones are not common? beta-2 agonists – such as salbutamol, salmeterol, formoterol and vilanterol. anticholinergics – such as ipratropium, tiotropium, aclidinium and glycopyrronium. theophylline. Therapeutic effects Oral versus IM Oral versus IV Oral versus Inhaled Inhaled versus IM IM versus IV Which one would have a more rapid therapeutic effect? (Figure it out for each one) What are the effects of a beta-2 receptor agonist? β2 adrenergic agonists' effects on smooth muscle cause dilation of bronchial passages, vasodilation in muscle and liver, relaxation of uterine muscle, and release of insulin. They are primarily used to treat asthma and other pulmonary disorders, such as Chronic obstructive pulmonary disease (COPD). What are examples of Leukotriene modifiers? Some examples of leukotriene modifiers are montelukast sodium. What is the patient education for alendronate? Morning w/ 8 oz of water What are examples of inhaled anticholinergic medications? Tiotropium (Spiriva Review how to read a medication order What is salicylate toxicity? chronic poisoning with a salicylate such as aspirin. Tinnitus and hearing loss What causes Reye’s Syndrome? Aspirin What are the five categories for drug safety in pregnancy? What ones are safe and what ones are not safe? D safe? Know your insulin chart What ones are compatible? Novolog (Lispro) and Humalog (Aspart), Rapid acting insulin, can be mixed with NPH if provided by the same manufacturer and are administered within 15 minutes after mixing. What one can be given IV? REGULAR What are adverse effects of ciprofloxacin? Can cause rhabdomyolysis, (tearing of Achilles tendon) stop medication immediately What is the patient education for alendronate? What is the action of bisphosphonates? Bisphosphonates decrease the number and action of osteoclasts, which thereby inhibits bone resorption. ● Therapeutic Uses Prophylaxis and treatment of postmenopausal osteoporosis In male clients who have osteoporosis Prophylaxis and treatment of osteoporosis produced by long-term glucocorticoid use For clients who have Paget’s disease of the bone and hypercalcemia of malignancy What are examples of bisphosphonates? Select Prototype Medications: alendronate (Fosamax) ● Other Medications ◯ Ibandronate (Boniva) ◯ Risedronate (Actonel) ◯ For IV infusion – zoledronic (Reclast, Zometa) What are the two actions for teriparatide? Chapter 75 pg 915 It (1) increases bone resorption by osteoclasts (2) increases bone deposition by osteoblasts. What is the action of disease-modifying antirheumatic drugs? DMARDs slow joint degeneration and progression of rheumatoid arthritis. What labs are monitored for methotrexate and what is the patient education for this medication? Testing may include a complete blood count (CBC) to measure red blood cell counts, white blood cell counts, and platelets; a blood urea nitrogen (BUN) and creatinine to evaluate kidney function; and a liver panel (or one or more of its component tests) to evaluate liver function. patients who are taking methotrexate to expect hair loss and to report any unusual bleeding or bruising. Because of the possibility of infection, avoid areas with large crowds or gatherings. Foods that are too hot or too cold or rough in texture may be irritating to the oral mucosa. Fluid intake is to be encouraged to prevent dehydration. What are examples of disease-modifying antirheumatic drugs? DMARDs I – Major Nonbiologic DMARDs • Immunosuppressant medications: methotrexate (Rheumatrex), leflunomide (Arava) • Antimalarial agents: hydroxychloroquine (Plaquenil) • Anti-inflammatory medication: sulfasalazine (Azulfidine) • Tetracycline antibiotic: minocycline (Minocin) ● DMARDs II – Major Biologic DMARDs ◯ Tumor necrosis factor antagonists ■ Etanercept (Enbrel) ■ Infliximab (Remicade) ■ Adalimumab (Humira) ◯ B-lymphocyte-depleting agent ■ Rituximab (Rituxan) ◯ Interleukin-1 receptor antagonist ■ Abatacept (Orencia) ● DMARDs III – Minor Nonbiologic and Biologic DMARDs ◯ Gold salts: auranofin (Ridaura) ◯ Penicillamine (Cuprimine, Depen) ◯ Immunosuppressant medications: azathioprine (Imuran), cyclosporine (Sandimmune, Gengraf, Neoral) What is the treatment plan for H-pylori and what is the action of the medications used to treat H-pylori? The antibiotic clarithromycin is active against H. pylori and is used in combination with omeprazole to eradicate the bacteria. First-line therapy against H. pylori includes a 10- to 14-day course of a proton pump inhibitor such as omeprazole, plus the antibiotics clarithromycin and either amoxicillin or metronidazole, or a combination of a proton pump inhibitor, bismuth subsalicylate, and the antibiotics tetracycline and metronidazole. Many different combinations are used. What is the action of proton pump inhibitors? Peptic ulcer disease Proton pump inhibitors block the final step of gastric acid production to prevent reflux in sliding hiatal hernia. What is the patient education for sodium bicarbonate? Excessive use of sodium bicarbonate may lead to systemic alkalosis. If you are using sodium bicarbonate as an antacid, it should be taken 1 to 2 hours after meals, with a full glass of water. If you are using sodium bicarbonate for another reason, it may be taken with or without food. Do not take sodium bicarbonate on an overly full stomach. What is the patient education for anti-diarrheal medications? Take anticholinergic drugs because they smooth muscle tone of the gastrointestinal tract. What is the treatment plan for inflammatory bowel disease? Anti-inflammatory drugs are often the first step in the treatment of inflammatory bowel disease. Anti-inflammatories include corticosteroids and amino salicylates, such as mesalamine What are examples of inflammatory bowel disease? What are examples of stimulant laxatives? Can cause dependency Stimulant laxatives: bisacodyl › Stimulant laxatives result in stimulation of intestinal peristalsis. › Prepare client prior to surgery or diagnostic tests such as a colonoscopy › Short-term treatment of constipation caused by high-dose opioid use What is an Osmotic laxative? EXPECTED PHARMACOLOGICAL ACTION: Osmotic laxatives draw water into the intestine to increase the mass of stool, stretching musculature, which results in peristalsis. THERAPEUTIC USES ● Low dose: Prevent painful elimination (clients who have episiotomy or hemorrhoids). ● High dose: Client preparation prior to surgery or diagnostic tests, such as a colonoscopy. ● Rapid evacuation of the bowel after ingestion of poisons or following anthelmintic therapy to rid the body of dead parasites. Can cause dehydration What are examples of proton pump inhibitors? Omeprazole? What are the major toxicities of chemotherapy? What are the treatment plans? Chapter 101 Specifically, nausea/vomiting Nausea and vomiting can be reduced by premedication with antiemetics. These drugs offer three benefits: (1) reduction of anticipatory nausea and vomiting, (2) prevention of dehydration and malnutrition secondary to frequent nausea and vomiting, and (3) promotion of compliance with chemotherapy by reducing discomfort. Combinations of antiemetics are more effective than single-drug therapy. The regimen of choice for patients taking highly emetogenic drugs consists of aprepitant [Emend], dexamethasone, and a serotonin antagonist, such as ondansetron [Zofran]. Specifically, neutropenia Colony-stimulating factors can minimize neutropenia. Three preparations are available: granulocyte colony-stimulating factor (filgrastim), long-acting granulocyte colony-stimulating factor (pegfilgrastim), and granulocyte-macrophage colony-stimulating factor (sargramostim). All three drugs act on the bone marrow to enhance granulocyte (neutrophil) production. Colony-stimulating factors can decrease the incidence, magnitude, and duration of neutropenia. As a result, they can decrease the incidence and severity of infection as well as the need for IV antibiotics and hospitalization. Specifically, alopecia To some degree, hair loss can be prevented by cooling the scalp while chemotherapy is being administered. Cooling causes vasoconstriction, and thereby reduces drug delivery to hair follicles. Unfortunately, scalp cooling is uncomfortable, causes headache, and creates a small risk for cancer recurrence in the scalp (because drug delivery is reduced). What are nursing interventions for chemotherapy? Zofran pretreat, relax environment What is teratogen-induced fetal malformations and when does it occur? Cleft palate, heart defects/ During the embryonic period of pregnancy What medication should patients not take with liver damage? What are the adverse effects for trimethoprim/sulfamethoxazole (TMP/SMZ)? Kernicterus bilirubin in the brain. Can cause slight dysfunction, or major What are the adverse effects of ciprofloxacin? Can cause rhabdomyolysis, (tearing of Achilles tendon) stop medication immediately What test is monitored during INH therapy? (TB therapy) Isoniazid (INH) Given for latent and active TB Can cause hepatotoxicity (liver failure) frequent liver enzyme function tests need to be done What does flumazenil treat? benzodiazepine overdose in adults. What does naloxone treat? Opioid overdose. What are signs and symptoms for hypothyroidism and hyperthyroidism? Symptoms hypothyroidism Weight gain Fatigue slow mentation Dry brittle hair Intolerance to cold Facial puffiness, pallor, expressionless Manifestations of hyperthyroidism Intolerance to heat Insomnia Tachycardia Dysrhythmias Rapid thought Rapid speech Weight loss Exophalmus Cefotetan On the exam Xanthine aminophylline What type of juice causes effects on how medications are absorbed or metabolized? Grapefruit What are signs/symptoms of lithium toxicity? Nausea/vomiting/diarrhea Hand tremors Unstable gait What are signs/symptoms for an overdose of tricyclic antidepressants? What are the drug to drug interactions for birth control? What are therapeutic goals of levodopa/carbidopa? What is the patient education for venlafaxine? Why do patients take docusate sodium? What is a bulk laxative? What are the drug to drug interactions for colchicine? What are the adverse effects? Chapter 74 pg 896 What are the drug to drug interactions for allopurinol? What are the adverse effects? Chapter 74 pg 897-897 What are the adverse effects for the five beta blockers used to treat glaucoma? Chapter 104 pg What are the five beta blockers used to treat glaucoma? Chapter 104 pg What is the patient education for latanoprost? Chapter 104 pg What is isotretinoin used to treat and what is the patient education for this medication? Chapter 105 pg What are the adverse effects of topical glucocorticoids? Damage of dermis and epidermis What medication are used to treat constipation cause by opioid use? naloxene What are complications of laxative abuse? Abdominal pain, cramps What is the patient education about food for MAOIs? NO, SALAMI What is sodium nitroprusside? hypertensive crisis What are adverse effects for ACE inhibitors (-pril)? Dry cough What labs are used to check therapeutic levels for warfarin ( INR) VITAMIN K and heparin? aPTT ( P. sulfate) What are the adverse effects of ARBs? angioedema How do you treat anaphylactic shock? Epinephrine