(COMBINED) Pharmacology WEEK 1, Pharm Week 7 Quiz 4 *Cardiac*, Quiz wk 13, Pharm Exam 5 Antimicrobial Drugs Review, Wk 11 Quiz Pharmacology Review, Wk 10 Pharm (Endocrine Drugs), Wk 9 Pharm (Gastrointestinal Drugs), Wk 10 Pharm (Endocrine Drugs), Wk 9 Pha

(COMBINED) Pharmacology WEEK 1, Pharm Week 7 Quiz 4 *Cardiac*, Quiz wk 13, Pharm Exam 5 Antimicrobial Drugs Review, Wk 11 Quiz Pharmacology Review, Wk 10 Pharm (Endocrine Drugs), Wk 9 Pharm (Gastrointestinal Drugs), Wk 10 Pharm (Endocrine Drugs), Wk 9 Pharm, 2024/2025. COMPLETE . Autonomy self-government Beneficence Doing good or causing good to be done; kindly action Justice Respecting the rights of others and giving them what is rightfully theirs Pharmacokinetics what the body does to the drug Pharmacodynamics what the drug does to the body Drug absorption movement of drug from site of administration into the blood Disintegration the breakdown of a tablet into smaller particles Dissolution Combining small drug particles with liquid to form a solution first pass metabolism Phenomenon in which the liver metabolizes some of a drug before it can circulate through the body, particularly when the drug has been taken orally. Bioavailability the extent to which the body can absorb and use a nutrient Factors that affect bioavailability -drug form -route of admin -GI mucosa and motility -food and other drugs -changes in liver metabolism Drug metabolism (biotransformation) -The metabolism of the drug by altering its chemical structure -Most drugs are metabolized by the LIVER Cytochrome P450 system (P450 system) ◦Drug-metabolizing enzymes in the liver ◦Convert drugs to metabolites Prodrug A drug that is inactive in its given form and must be metabolized to its active form in the body, generally by the liver, to be effective. Drug half-life the time required for the amount of drug in the body to decrease by 50% Steady state ◦Occurs at approximately 4 half-lives Loading Dose use of a higher dose than what is usually used for treatment to allow the drug to reach the critical concentration sooner Maximal efficacy the largest effect that a drug can produce Receptor theory most drugs produce their actions by activating or inhibiting specific cellular receptors Therapeutic Index the ratio between the toxic and therapeutic concentrations of a drug Agonists Activate receptors and produce desired response Partial Agonists drugs that interact with a receptor to stimulate a response but inhibit other responses Antagonists (drugs) These drugs block the actions of neurotransmitters Nonspecific or nonselective drugs ◦Affect multiple receptor sites Cinnamon ◦Used to treat bronchitis, GI problems, anorexia, diabetes ◦May decrease blood clotting Echinacea ◦Stimulates immune system (treat colds, flu, infections) ◦Side effects-GI effects, allergic reactions Garlic ◦Used to lower cholesterol, blood pressure and reduce heart disease, preventing stomach and colon cancer ◦Side effects-heartburn, upset stomach, body odor, decreased blood clotting Ginger ◦Used for nausea, motion sickness, diarrhea, relieves pain, swelling, arthritic stiffness ◦Safe in pregnancy ◦Side effects-gas, bloating, heartburn, nausea Ginkgo biloba ◦Used for asthma, bronchitis, fatigue, tinnitus, sexual dysfunction, multiple sclerosis, to improve memory, decrease intermittent claudication ◦Side effects-headache, dizziness, nausea, GI upset, increased bleeding, allergic reactions. Ginseng ◦Improves well-being, stamina, and immune system, erectile dysfunction, hepatitis C, menopausal symptoms, lowers glucose and blood pressure ◦Side effects-headaches, GI distress, hypertension, hypoglycemia, breast tenderness, menstrual irregularities, allergic reactions. Green tea ◦Improves mental alertness, relieves headache, protects against heart disease and cancer, promotes weight loss ◦Contains caffeine ◦Adverse effects-liver dysfunction Licorice root ◦Used for bronchitis, sore throat, stomach ulcers, viral hepatitis. ◦High doses can lead to salt and water retention, hypertension, low potassium level Kava kava ◦Used for relaxation and anxiety ◦Adverse effects include liver damage; dry, scaly, yellowing skin; eye irritation, heart problems Milk thistle ◦Used for hypercholesterolemia, insulin resistance, chronic hepatitis, cirrhosis, gallbladder disorders ◦Side effects include upset stomach, hypoglycemia, allergic reactions St. John's wort ◦Used for mental disorders, nerve pain, sleep disorders, malaria, wounds ◦Drug interactions-antidepressants (serotonin syndrome), birth control pills, cyclosporine, digoxin, indinavir, irinotecan, drugs for seizure control, and anticoagulants ◦Side effects include anxiety, dry mouth, dizziness, headache, fatigue, sensitivity to sunlight, GI problems, sexual dysfunction Turmeric ◦Used for heartburn, stomach ulcers, gallstones, inflammation, cancer. ◦High doses may cause nausea, diarrhea Valerian ◦Used for anxiety, headache, insomnia, tremors, depression, irregular heartbeat ◦Side effects include headache, dizziness, fatigue, stomach upset Patient Education o Do not take if taking prescription drugs without checking with heath care provider o Do not take if pregnant or nursing o Do not give herbs to infants/young children o Some herbal products can alter laboratory test results o Follow label instructions o Discontinue if side effects are disturbing and contact health care provider o Herbs may contain multiple compounds and not on label oDiscontinue herbal therapy 2 to 3 weeks before surgery Potassium**** - Primary intracellular cation - Normal serum range: 3.5 to 5.0 mEq/L - Transmission and conduction of nerve impulses for contraction of skeletal, cardiac, and smooth muscles, acid base balance - Take with water; diluted via IV infusion pump; Not crushed; monitor K+, ECG, IV site - Fruits/Nuts/Spinach - S/S of excess: paresthesia of body parts - S/S of depletion: dysthymias - Affects T wave via ECG - Treatment: Dextrose + regular insulin IV, sodium bicarbonate, Kayexalate, dialysis Sodium - Primary extracellular cation - Normal serum range: 135 to 145 mEq/L - Conduction of nerve impulses; Reflects the ratio of sodium to water; WATER FOLLOWS SODIUM! - Replace sodium with IVF: NSS or hypertonic saline if severely lo - requirement: 2000 mg to 4000 mg daily - S/S of excess: elevated BP and T; neurovascular issues - S/S of depletion: Altered mental status; cerebral edema - Treatment: free water, sodium restriction, diuretics Calcium - Mineral and extracellular cation - Normal serum range: 8.6 to 10.2 mg/dL - Transmission of nerve impulses and contraction of skeletal and heart muscles; Formation of bones and teeth - Oral; IV; Calcium gluconate (maintenance); Calcium chloride (cardiac arrest); Adequate vitamin D levels needed for absorption; Low magnesium levels may prevent the patient from responding to treatment for hypocalcemia - S/S of excess: hyperactive deep tendon reflexes, tetany - S/S of depletion: depressed deep tendon reflexes, weakness - Treatment: diuretics + IVF Magnesium*** - Mineral and intracellular cation - Normal serum range: 1.5 to 2.5 mEq/L - Promotes transmission of neuromuscular activity and myocardium contraction; Transports sodium and potassium across cell membranes - Oral; IV magnesium sulfate used to stop pre-term labor and convulsions during labor; Magnesium toxicity: treat with calcium gluconate - Many OTC GI products; laxatives, antacids; Green vegetables, bananas, fish, grains, and nuts - S/S of excess: tremors/twitching - S/S of depletion: loss of deep tendon reflexes; paralysis; heart block Chloride - Primary extracellular anion - Normal serum range-96 to 106 mEq/L - Major contributor to acid-base balance, gastric juice acidity, and the osmolality of ECF, Often mirrors the actions of sodium S/S of depletion: tremors, twitching, and slow, shallow breathing S/S of excess: weakness, lethargy, rapid breathing, unconsciousness Phosphorus - Primary intracellular anion - Normal serum range- 2.4 to 4.4 mEq/L - Essential in bone and teeth formation, neuromuscular activity, pH balance; High phosphate level causes low calcium level, low calcium level causes high phosphorus level; Regulation of phosphate balance requires adequate renal function - Whole-grain cereals, nuts, milk, and meat - S/S of depletion: paresthesia, bone pain, hyporeflexia, hyperventilation, anorexia, dysphagia - S/S of excess: hyperreflexia, flaccid paralysis metoprolol (Lopressor); atenolol (Tenormin) - beta blockers - Decrease HR and BP - Use: HF, arrhythmias, hypertension, stable angina, atrial fibrillation, migraines - S/E: Bradycardia, hypotension, peripheral edema, bronchospasms, erectile dysfunction digoxin (Lanoxin)***** - cardiac glycoside - Increases myocardial contractility and force of contraction; Improves stroke volume and cardiac output; Decreases heart rate - Use: Heart failure, atrial arrhythmias - Oral; IVP (least 5 minutes) - Therapeutic serum levels - 0.5-0.8 ng/mL - Monitor serum potassium levels**** - S/E: Bradycardia, cardiac dysrhythmias - Contraindications: Hypokalemia/digoxin toxicity; Hyperkalemia/decreased therapeutic levels; Ventricular arrhythmias, heart block; Acute decompensated heart failure; Many herbal supplement interact with digoxin - Considerations: apical pulse before administration; edema; digoxin/K+ levels; no antacids milrinone lactate (Primacor) - phosphodiesterase inhibitor - Increases stroke volume and cardiac output; Promotes vasodilation - Use: Acute decompensated heart failure - IV: no longer than 48 to 72 hours to avoid dysrhythmias; Continuous ECG monitoring - S/E: headache; dysrhythmias; nausea; hypokalemia, thrombocytopenia, and angina Nonpharmacologic Therapy for Heart Failure - Limit: salt, fluid, saturated fat, alcohol, smoking - Exercise at least 3times/week procainamide (Pronestyl); lidocaine; propafenone (Rythmol) Class I Antidysrhythmics - Black box warning: may cause lupus like syndrome; - Not for long term use due to toxicity; - Increases digoxin and anticoagulant levels, Grapefruit may cause toxicity - Contraindications for all: heart block, HF, shock, electrolyte disturbances, Caution with other antiarrhythmics and digoxin therapy Adenosine Class II Antidysrhythmics - Beta adrenergic Blockers - Drug of choice to terminate SVT; Very short half-life; Continuous ECG monitoring - Dose: 6 mg, 12 mg, 12 mg - Contraindications: Concurrent use of theophylline, caffeine Heart block, bradycardia, Afib/flutter, Pregnancy; Caution in adults with CPOD or asthma amiodarone; sotalol (Betapace); dofetilide (Tikosyn) Class III Antidysrhythmics - Drug of choice for ventricular arrhythmias, Highly toxic with long-term use, Monitor PFTs, LFTs, TFTs, Monitor for QT prolongation; - Continuous ECG monitoring for initiation of therapy, Monitor electrolytes closely, Monitor for QT prolongation; - Contraindications: HF, heart block, bradycardia, prolonged QT diltiazem (Cardizem); verapamil (Calan) Class IV Antidysrhythmics - Commonly used IV to treat atrial fibrillation with RVR; - Commonly used to treat SVT, May cause peripheral edema; - Contraindications: Heart block, HF, hypotension, Grapefruit may cause toxicity. - Calcium Channel Blocker. Nursing Considerations for Antidysrhythmic Drugs - Monitor vital signs, ECG, electrolytes, renal and liver function - Assess for signs and symptoms of heart failure - Advise patient to report S/E and A/E, and to avoid alcohol, caffeine, and tobacco - Educate patients about postural/orthostatic hypotension hydrochlorothiazide (HCTZ) Thiazide diuretic - Blocks reabsorption of sodium and chloride - Use: First line treatment for hypertension; Mild to moderate peripheral edema; Safe to combine with antihypertensives; Patients must have normal renal function - S/E: Hypercalcemia; Hyperlipidemia furosemide (Lasix); bumetanide (Bumex) loop diuretics - Blocks reabsorption of sodium and chloride, Strong diuretic, even with renal impairment - Use: Urgent need for fluid removal - HF, liver or kidney disease - S/E: Ototoxicity; Marked depletion of electrolytes Contraindications: Anuria; NSAIDS spironolactone (Aldactone)******** potassium sparing diuretic - Blocks action of aldosterone, Promotes sodium/water excretion and potassium retention - Use: HF, cirrhosis - S/E: Hyperkalemia, Males - deepened voice, Females - menstrual irregularities - Contraindications: Concurrent use of other potassium sparing diuretics, potassium supplements, ACE inhibitors, angiotensin receptor blockers mannitol osmotic diuretic - Increases serum osmolality, Decreases intracranial pressure (ICP) and intraocular pressure (IOP) - Use: Cerebral edema, hypovolemic shock; Intravenous infusion - must use filtered needle and filtered IV tubing - S/E: HF, rebound increased ICP, electrolyte imbalances, metabolic acidosis - Contraindications: Intracranial hemorrhage, pulmonary edema, dehydration, renal failure Nursing Considerations for Diuretics**** - Monitor vital signs (especially BP), electrolytes (especially potassium), blood glucose, uric acid, and lipid levels, daily weight and urine output, S/S of hypokalemia, HYPOTENSION, urine output less than 30 ml/hr - Evaluate effectiveness of treatment Patient Education for Diuretics - Advise patient to take in the morning to avoid sleep disturbance from nocturia; slowly change positions from lying to standing; track daily weights fluid restrictions or adequate fluid intake; licorice may decrease potassium levels - Teach patient sources of dietary potassium: Bananas, potatoes, dried fruits, nuts, spinach, citrus fruits, dates, salt substitutes Acute Angina A short-term chest pain caused by reduced blood flow to the heart. It is often precipitated by exertion and associated with cardiovascular disease - Treatment: nitroglycerin - must be protected by light, keep in original bottle - Still potent if it fizzles under the tongue - If you take a second tablet, CALL 911