NURS 350 : PHARMACOLOGY FINAL EXAM STUDY GUIDE

CONCEPTS: Rights of Medication Administration Medication Errors Drug Classification Drug Tolerance - Body develops a physiological tolerance to the drug over time and higher doses of the drug are needed to produce a therapeutic effect Resistance and Dependence - Resistance: commonly occurs with abx, usually due to overuse or misuse - Dependence: body develops a physiological need for the drug to avoid withdrawal Nursing Process - Assessment - Diagnosis - Planning - Implementation - Evaluation Adrenergic and Cholinergic Drugs - Adrenergic drugs → sympathetic NS receptors - Sympathetic NS: increase HR, increase BP, tachycardia, decreased urine production, dry eyes - Cholinergic drugs → parasympathetic NS receptors - Parasympathetic NS: decrease HR, decrease BP, bradycardia, increased urine production Eye Drops - Cycloplegic eye drops → produce mydriasis (pupil dilation) for eye exams and to allow for greater outflow of AH to lower IOP - Cholinergic eye drops → produce miosis (pupil constriction) to stretch the trabecular meshwork to allow for greater outflow of AH to lower IOP - Adverse effects: headache, induced myopia, and decreased vision in low light - Example: pilocarpine (Isopto-Carpine) - Mydriatic eye drops → cause pupil dilation - Miotic eye drops → cause pupil constriction - Beta-blocker eye drops → decrease production AH to lower IOP - Contraindicated for patients with asthma or HF - Example: timolol (Betimol) Use of Probiotics - Used to maintain normal flora in the body during abx use to avoid secondary infections (ex. yeast infection, candidiasis) Antacids → provide temporary relief from heartburn or indigestion - Aluminum compounds → constipation - Calcium compounds → constipation - Magnesium compounds → diarrhea Vitamin B12 - Vitamin supplement for pernicious anemia or absence of intrinsic factor Use of Neuromuscular Agents Risk for Hormone Replacement Therapy and Contraceptives IV Fluid Therapy for: restoration of fluids and electrolytes, shock, sepsis, maintain BP NURS 350 : PHARMACOLOGY FINAL EXAM STUDY GUIDE Electrolyte Imbalances - Hyponatremia → low sodium (Na+) → excessive water - Hypernatremia → high sodium (Na+) → dehydration - Hypokalemia → low potassium (K+) → dysrhythmias, cardiac conduction dysfunction - Hyperkalemia → high potassium (K+) → dysrhythmias, cardiac conduction dysfunction Treatment for Thyroid Disorders - Hyperthyroidism → elevated thyroid function, Grave’s disease - Treatment: Propylthiouracil (PTU), methimazole (Tapazole), radioactive iodine - Hypothyroidism → inadequate thyroid function, Hashimoto’s disease - Treatment: levothyroxine (Synthroid) - Thyroid Cancer - Treatment: surgery, radioactive iodine, levothyroxine therapy Treatment for Diabetes Mellitus - Type 1 DM → caused by the autoimmune destruction of pancreatic beta cells, resulting in lack of insulin secretion - Typical signs and symptoms: hyperglycemia, polyurina, polyphagia, polydipsia, glucosuria, weight loss, fatigue - Treatment: insulin replacement therapy (rapid-acting or long-acting) - Type 2 DM → caused by unresponsive target cells resulting in insulin resistance - Treatment: usually managed with antidiabetic drugs, insulin may be needed for additional management - Antidiabetic drugs: biguanide (metformin), sulfonylureas (chlorpropamide, glimepiride) Antidepressants - Monoamine Oxidase Inhibitors (MAOIs) - Drug for depression - Limit the breakdown of norepinephrine, dopamine, and serotonin in the CNS to create higher levels of these neurotransmitters to alleviate symptoms of depression - Low safety margin, these drugs are reserved for patients who have not responded to SSRIs or TCAs - Avoid foods with tyramine (may cause HTN crisis) - Example: phenelzine (Nardil) - Adverse effects: orthostatic hypotension, headache, insomnia, diarrhea, serotonin syndrome, hepatotoxicity - Selective serotonin reuptake inhibitors (SSRIs) - Drug of choice for depression and anxiety - Examples: escitalopram (Lexapro), sertraline (Zoloft) - Adverse effects: weight gain, sexual dysfunction, serotonin syndrome - Tricyclic Antidepressants (TCAs) - Treats depression and anxiety - Examples: amitriptyline (Elavil), imipramine (Tofranil) - Adverse effects: anticholinergic effects (dry mouth, blurred vision, urine retention, constipation, HTN) - Contraindications: patients with a history of myocardial infarction, heart block, or arrhythmia - Interactions: use with alcohol or other CNS depressants MEDICATIONS: Ibuprofen (Advil, Motrin) - Pharmacologic Class: non-steroidal anti-inflammatory (NSAID) - Therapeutic Class: nonopioid analgesic, antipyretic, NSAID - Uses: mild to moderate pain, inflammation, fever - Mechanism of Action: inhibit cyclooxygenase (COX), an enzyme responsible for the formation of prostaglandins, to reduce inflammation and pain - Inhibits pain mediators at the nociceptor level (non-selective) - Adverse Effects: nausea, heartburn, epigastric pain, dizziness, GI ulcers, peripheral edema, aplastic anemia, leukopenia, prolonged bleeding, anaphylaxis, nephrotoxicity, ototoxicity - Contraindications: peptic ulcers, kidney disease, CVD, HTN, HF, MI - Interactions: other anticoagulants - Nursing Considerations: - Give the drug on an empty stomach as tolerated. If GI upset occurs, give with food. - Patients with asthma or allergies to aspirin are more likely to exhibit a hypersensitivity reaction to ibuprofen. - Monitor intake and output - Monitor kidney and liver function studies - Monitor for GI upset, black or tarry stools, hypotension, signs of GI bleeding - Monitor for hearing loss or changes - Pregnancy Category: C, changes to D after 30 weeks gestation Aspirin (Acetylsalicylic Acid, ASA) - Pharmacologic Class: salicylate, non-steroidal anti-inflammatory (NSAID) - Therapeutic Class: nonopioid analgesic, NSAID - Uses: prophylaxis of cardiovascular events (anticoagulant activity), mild to moderate pain, inflammation, fever - Mechanism of Action: inhibit cyclooxygenase (COX), an enzyme responsible for the formation of prostaglandins, to reduce inflammation and pain - Inhibits pain mediators at the nociceptor level (non-selective) - Adverse Effects: gastric discomfort and bleeding, prolonged-bleeding time, nephrotoxicity, ototoxicity - Contraindications: - Interactions: other anticoagulants - Nursing Considerations: - Medication should be discontinued 7 days prior to surgery - Excreted in the urine and may affect urine testing for glucose and other metabolites - Monitor for GI upset, black or tarry stools, hypotension, signs of GI bleeding - Monitor for hearing loss or changes - Pregnancy Category: D