NUR 2407-FINAL EXAM STUDY GUIDE

NUR 2407-FINAL EXAM STUDY GUIDE PHARMACOLOGY FINAL EXAM STUDY GUIDE-100 POINTS Schedule Drugs:  Schedule I (C-I): High abuse potential and no accepted medical use (heroin, marijuana, LSD).  Schedule II (C-II): High abuse potential with severe dependence liability (narcotics, amphetamines, and barbiturates).  Schedule III (C-III): Less abuse potential than schedule II drugs and moderate dependence liability (non-barbiturates sedatives, non-amphetamines stimulates, limited amts of certain narcotics)  Schedule IV (C-IV): Less abuse potential than schedule III and limited dependence liability (some sedatives, anti-anxiety agents, and non-narcotic analgesics).  Schedule V (C-V): Limited abuse potential. Primarily small amts of narcotics (codeine) used as antitussives or antidiarrheals. Under Federal Law, limited quantities of certain schedule V drugs may be purchased without a Rx directly from a pharmacist. The purchaser must be at least 18 years old and must furnish suitable identification. All such transactions must be recorded by the dispensing pharmacist. Antidotes:  Digoxin: Digibind or Dig Fab  Heparin: Protamine Sulfate  Coumadin: Vitamin K  Levothyroxin: Propythiuracil  Opiates: Naloxone (Narcan)  APAP (Tylenol): Mucomyst  Benzodiazapines: Romazicon ( flumazenil)  Atropine: Physostigmine  Barbiturates: activated charcoal ( turbutamide) Gout: is a disease in which defective metabolism or uric acid causes arthritis, especially in the smaller bones of the feet, deposition of chalkstones, and episodes of acute pain. Increase in uric acid levels. It is a risk factor for CAD.  Gout meds block the cause of inflammation in gout: Uric Acid  Goal is diminished uric acid effects  Colchicine: Prevents inflammatory response to uric acid crystals  Zyloprim (allopurinol): prevents uric acid production  Benemid (probenecid): locks uric acid in the urine  Zyloprim and Benemid are nephrotoxic APAP (Tylenol):  Antipyretic, non-opioid analgesic does not have the anti-inflammatory effects of the salicylates or the NSAIDS. Blocks COX3 for fever and pain but not inflammation (COX2); available OTC. Acts peripherally to limit neurochemicals of pain. APAP can be extremely toxic. It causes SEVERE LIVER TOXICTY that can lead to death when taken in high dose and high BP in women with long-term use. Limit daily intake in alcoholics and elderly. No more than 2,000 mg/day in frail elders and 4,000 mg daily limit in adults. APAP should be given separely when high doses of opiates are needed; can be given with Oxycontin or MS Contin (Long-acting morphine) but is is also given between the Q12 hr doses of these opiates. No bleeding risks but can enhance effects of Coumadin. Opioids:  Were first derived from the opium plant. Although most narcotics are now synthetically prepared, their chemical structure resembles that of the original plant alkaloids. All drugs in this class are similar, in that they occupy specific opioid receptors in the CNS. Their actions in the body are related to the stimulation of the various opioid receptors they occupy. Narcotic agonist, narcotic-agonist-antagonist, and narcotic antagonist. Opioid receptors Mu, Kappa, Delta. Antibiotics:  Take full course of antibiotics. Not completing the full dose leads to antibiotic resistance. A back up form of birth control is needed when taking ABX and oral contraceptives. Take ABX only for a bacterial infection- are not effective against viruses and leads to drug resistant bacteria. Supra-infection: bacterial resistance that creates infections difficult to treat and often resistant to multiple drugs. Stop IV ABX if difficulty breathing and lightheadedness occurs-contact the MD.  Amoxicillin o Therapeutic Actions/Indications: Tx of infections caused by susceptible strains bacteria, post-exposure prophylaxis for anthrax, and treatment of H.pylori infections as part of combination therapy. Extended-spectrum pencillins. o Nursing Considerations: These drugs are contraindicated in pts with allergies to penicillin or cephalosporins or other related allergens. Use with caution in pts w/ renal dz. Pregnant or lactating pts should be limited to situations in which the mother clearly would benefit from the drug. Diarrhea and superinfections may occur in the infant. Perform C&S tests to ensure that the causative organism is sensitive to penicillin selected to use. With the emergence of many resistant strains of bacteria, this has become increasingly important. TAKE ON AN EMPTY STOMACH but take with water for kidney’s sake. Interacts with birth control so use barrier contraceptives. People easily develop allergies. o Adverse Effects: N/V, diarrhea, glossitis, stomatitis, bone marrow suppression, rash, fever, superinfections, lethargy.  Cephalosporins o Similar pharmacologic properties as PCN. Largest ABX class; selection based on sensitivity. Generic names being with “cef” or “ceph” o Indications: Gram negative infections and pts who can’t tolerate less expensive PCNs o Adverse Effects: similar to PCN. 5-10% allergic to PCN, also allergic to cephalosporins. o Examples: cefazolin (Ancef), cefotentan (Cefotan), cefuroxime (Zinacef), ceftrioxone (Rocephin).  Vancomycin (Vancocin, Vancoled) o Indications: Interferes with cell wall synthesis in susceptible bacteria. This antiinfective drug can be used orally or IV to treat life-threatening infections when less toxic drugs cannot be used. It is used orally as prophylaxis against bacterial endocarditis in pts who cannot take PCN or Cephalosporins and to treat staph infections in people who cannot take these groups of drugs. o Nursing Considerations: Because Vanco may be highly toxic, its use is reserved for very special situations. When it is the only ABX that is effective against a specific bacterium, however, the benefits outweigh the risks. o Adverse Effects: It can cause renal failure, ototoxicity, superinfections, and a conditions known as “Red Man Syndrome” which is characterized by sudden and severe hypotension, fever, chills, paresthesias, and erythema of the neck and back.  Ciprofloxacin (Cipro) o Fluoroquininlone Classification o Indications: Tx of infections caused by a wide spectrum of gram-negative bacteria. Tx of respiratory, dermatological, UTI, ear, eye, bone, joint infections, Tx after anthrax exposure, typhoid fever. o Nursing Considerations: Contraindicated in preg. Or lactating pts. Use with caution in the presence of renal dysfunction and seizures. Because so many resistant strains are emerging, always perform a C&S tests of infected tissue to determine the exact bacterial cause and sensitivity. These drugs have been associated with lesions in developing cartilage and therefore are not recommended for use in children younger than 18 yo. o Adverse Effects: H/A, dizziness, hypotension, N/V, diarrhea, fever, rash. Increase risk of developing tendonitis and tendon rupture!  Metronidazole (Flagyl) o Antiprotozoals o Indications: Tx of amebiasis, trichomoniasis, giardiasis; acute intestinal amebiasis, amebic liver abscess, trichomoniasis, acute infections caused by susceptible strains of anaerobic bacteria, and pre-op and post-op prophylaxis for pts undergoing colorectal surgery. o Nursing Considerations: Contraindicated in pregnancy because drug effects on developing fetal DNA and proteins can cause fetal abnormalities and even death. Use caution when administering these drugs to pts with CNS disease because of possible disease exacerbation due to drug effects on the CNS; hepatic