PHARMACOLOGY EXAM 2023/2024 STUDY GUIDE QUESTIONS AND ANSWERS

PHARMACOLOGY PROCTORED EXAM • Drugs that PRODUCE a response? o Agonist • Drugs that PREVENT a response? o Antagonist • Therapeutic WINDOW is what? o Level of the drug between minimal effective concentration in the plasma for obtaining desired drug response and the minimal toxic concentration • The time it takes for ½ of the drug concentration to be eliminated from the body is called? o Half life • What is a patient on two highly protein bound drugs at risk for o Accumulation and toxicity o A decreased responsiveness over the course of therapy which may lead to the need to increase dosages to attain the same effect tolerance • What is it called for drugs to share many common features o Classification or class • What makes drugs fit into the same “class” o Related by chemical structure o Work in the same way o Used for the same purpose • Another name for antagonist? o Adrenergic blocker • Who do you not give antagonist or adrenergic blocker to? o Asthma client • Beta blockers commonly seen in what clients? o Hypertension • Antagonist suffix o LOL • Antagonist S/S o Decreased HR o Rest and digest o Bronchospasm • Agonist S/S o Increased HR, Fight or flight, Vasoconstriction, Increase blood sugar • Before administering antagonist what do you check o HR and BP • Cholinergic o Salivate, Lacrimation, Urinate, Defecate, Decreased weight • Anticholinergic o Can’t see, pee, spit, poop, and increase HR • What type of drug is Reglan? o Cholinergic • How do you treat cholinergic crisis o Atropine • Cholinergic crisis S/S o Flushing, sweating, nausea, ab cramping • Anticholinergic drugs are contraindicated in who? o Coronary artery disease (increase HR) o GI obstruction (constipation) o Supraventricular tachycardia (increase HR) • CNS stimulant drugs are contraindicated in who? o Coronary artery disease (cause vasoconstriction=heart attack) o Hypertension (additive hypertension=stroke) • Hemorrhagic stroke o Increase BP o Increase HR o Increased RR o Unresponsive to deep pain • Anorexiants can lead to what? o 16x greater risk for stroke • Most common side effects of Ritalin o Irritability o Insomnia  Weight loss  Decrease appetite • Benzodiazepines increase activity to what neurotransmitter (PAM & LAM) o GABA • Reversal to benzodiazepines o Flumazenil • Ambien side effects o Sedative/hypnotic o Suicidal ideation o Dependence o Abnormal behavior • Drug choice for treating status epilepticus o Diazepam’s • Dilantin can do what? o Cause gum disease o Treat seizures o Cause high BP o Cause birth defects o Decrease effectiveness of anticoagulants • When a client is on Dilantin what are some nursing interventions? o Monitor for narrow therapeutic index (freq blood test) o Take as prescribed o Oral care o Teach pt to use barrier contraceptives along with oral • What is therapeutic level for Depakote? o 40-100 • If Depakote levels are high (100) what needs to be done? o Hold meds o Check liver function with blood test o Discuss with DR o Neuro assessment o Check vitals • What does Depakote treat? o Epilepsy o Migraine Bipolar disorder • Benzodiazepines can lead to what? o Tolerance o Dependence o Withdrawal • Barbiturates reversal treatment o Activated charcoal • Example of barbiturates o Phenobarbital • What disease process goes with “dopamine depletion”, rigidity, acetylcholine accumulation, acetylocholinerase inhibitor drugs, facial masking, motor neuron degeneration and anticholinergic drugs o Parkinson’s disease • What disease goes with confusion, bradykinesia, memory loss, amyloid plaques, and neurofibrillary tangles o Alzheimer’s disease • Aricept improves what? o Cholinergic function • What is SLUD o Salivation, lacrimation, urination, defecation • You CANNOT crush CONTIN, POTASSIUM and IRON o You CAN crush calcium antacids • What disease process goes with “lack of Ach receptor sites”? o Myasthenia Gravis • What disease process goes with “respirator muscle weakness”? o Myasthenia gravis • What disease process goes with “anticholinesterase inhibitor drugs”? o Myasthenia gravis • What should you avoid while taking cyclobenzaprine (flexeral)? o Driving and alcohol • A patient is taking an MAOI and eating blue cheese and red wine with dinner, what should you tell them that they are at risk for? o Hypertensive crisis A patient is taking Lithium, you should advise them to avoid what other drugs? o Ibuprofen, ACE inhibitor, HCTZ • Serotonin syndrome S/S o Agitation, confusion, rigidity, fever • Extrapyramidal (EPS) effects are most common with which class of antidepressants? o Tricyclics • What to keep in mind with lithium? o It has a narrow therapeutic range, do not crush, check serum levels, take same time every day, and lab range is .4-.8 MeQ/L • What drugs contain acetaminophen? o Vicodin, Tylenol, Lortab, Norco, Excedrin, Nyquil, fioricet, Percocet, alka seltzer plus • What drugs do not contain acetaminophen? o Tramadol, gabapentin, flexeril, ketorolac, Motrin, dilaudid, Advil • What drug should not be given during an acute gout flare up? o Probenecid • What is an injectable NSAID? o Toradol • Ibuprofen should always be taken with? o Food or milk • All opioids can be reversed by what? o Narcan/naloxone • Max daily dose of acetaminophen for adults? o 3 grams/2 grams for elderly or liver/kidney damage • Common side effect of opioids are? o Respiratory depression, hypotension, increase intracranial pressure • Extra pyramidal symptoms? o Tardive dyskinesia, akathisia, acute dystonia • Neuroleptic malignant syndrome? o Sudden high fever, tachycardia, BP fluctuations, altered mental status, acute renal failure • The ONLY non-sedating anti-anxiety med is? o Buspar Typical antipsychotics may be prescribed for short term use why? o It is faster working • Extra pyramidal side effects are most commonly seen in which class of medications? o Typical antipsychotics • How do you know if a neuroleptic is working? o Positive change in behavior • What do you need to teach with DMARDS? o Good hygiene • What is pharmaceutics? o Applies only to tablets or capsules given by mouth (PO). The process in which the tablet or capsule becomes a solution so that it can cross the biologic membrane of the stomach or small intestine • Drugs generally disintegrate and are absorbed faster in what? o Very acidic fluids • Very old and very young people have less gastric acidity? o Lower/slower absorptiondrug in the system longer • If a drug is enteric coated and meant to be absorbed in where? o Small intestine, absorbed in the stomach • Pharmacokinetic phase o This is the process of drug movement to achieve drug action. Sometime referred to as what the body does to the drug • 4 processes o Absorption, distribution, metabolism, excretion • Protein bound drugs are destroyed by? o Digestive enzymes • Insulin is a protein bound drug, so CANNOT be given by which route? o Oral • Absorption drugs absorbed most easily are? o Fat soluble and non-ionized • What is the first pass effect? o The liver can inactive or change drugs into different forms • Bioavailability is what? The % of the administered dose that reaches systemic circulation • Bioavailability for IV administered drugs is what %? o 100% because of the bloodstream/vein contact • After a pill is taken by mouth, what organ has a major impact on its bioavailability? o Absorption, most oral drugs are absorbed through the action of mucosal villi in the small intestine. If the villi are damaged by disease or surgical intervention, the absorption of the drug is delayed or does not occur • High fat foods increase what? o Absorption time • Exercise can decrease drug absorption because? o Blood flow is in peripheral muscles instead of the GI tract • Protein binding is what? o As drugs circulate in the blood and plasma, some of them have a high affinity for binding to the plasma proteins. Drugs that are stuck onto the proteins aren’t free to go to their target receptor sites and do their jobs • If a patients in on 2 drugs that are both strongly protein bound, what happens? o The compete for binding sites on the protein, which means more free drugs will be released into active circulation, which can lead to accumulation and toxicity • The blood brain barrier is what?