NA 222 Comprehensive Pharmacology

Why is it important that patients have regular blood tests done for certain medications?

Blood levels must be drawn for many drugs (lithium, digoxin, phenytoin (etc..) because these drugs have a narrow range between a therapeutic dose and and a toxic dose. Periodic blood levels ensures that a therapeutic level has been reached and to prevent toxicity.

How can the nurse differentiate between angina and myocardial infarction (MI)?

Angina usually terminates with rest and nitrates and is rarely fatal. A MI requires immediate treatment and can be life threatening.

Before giving digoxin (cardiac glycoside) the nurse should take what precautions?

1.Monitor apical pulse for one full minute 2.DO NOT give if SBP , 90 mmHg and HR <60 bpm 3.Weigh daily, monitor I & O 4. Monitor serum digoxin level

What are the components of a complete medication order?

1.Name of the medication 2. Route of administration 3. Time the medication is to be given 4. Amount of medication to be given (dose) ****if any of the above are missing or need to be changed to meet patient needs the provider must be contacted for a new order

What are the 4 stages of drug approval?

1. Preclinical Investigation-Testing is performed on laboratory animals 2. Clinical Investigation-•Evaluation of drugs for human benefit and testing is performed on human subjects. Involves 3 phases. 3. New Drug Application Review-occurs during human testing and the new drug is either approved or rejected 4. Post-Marketing Studies-occurs after the new drug is placed on the market

What types of drugs inhibit the sympathetic nervous system?

*Adrenergic blockers *Sympatholytics

What types of drugs inhibit the parasympathetic nervous system?

*Anticholinergics *Parasympatholytics *Muscarinic Blockers

what is the pharmacologic class of a medication describing?

- How a drug produces its physiologic effect in the body -Often represents mechanism of action (MOA)—how a drug produces its physiologic effect in the body ▪Calcium Channel Blockers, Beta Blockers etc

Before administering any medications the nurse should have an understanding of what pharmacotherapeutic principles?

-What drug is ordered -Name (generic and trade) and classification -Intended or proposed use -Effects on the body -Contraindications -Special considerations -Adverse effects -Why the medication is prescribed to the patient -How the medication is supplied by pharmacy -How the medication is administered

What is the suffix for most calcium channel blockers?

-dipine

What is the suffix for beta-blockers?

-lol

What is the suffix for ACE inhibitors?

-pril

What is the serum therapeutic range for digoxin?

0.5-1.8 ng/mL

Why are some medications considered controlled and placed on a schedule?

A controlled substance is a drug whose use is restricted by the Controlled Substances Act of 1970 •Scheduled drugs are classified according to their potential for abuse See picture for specific medications in each category

Before administering antibiotics the nurse should ensure that what is done first?

All specimens (urine or blood) haver been obtained for culture and sensitivity testing

Alpha 1 adrenergic drugs effect what organs?

All sympathetic target organs (kidneys, eyes, bowels, lungs) except the heart

What are the most common uses for anticholinergic drugs?

Anticholinergic are most commonly used to dry secretions and to treat asthma

What class of drug is digoxin?

Cardiac Glycosides

What are the symptoms of serotonin syndrome?

Changes in mental status, hypertension, tremors, diaphoresis (sweating), hyperthermia (fever), and lack of muscular coordination

What are neurotransmitters?

Chemicals that allow nerve impulses to cross the synaptic cleft. The basic functional cell of the nervous system is the neuron. The chemicals that allow nerve impulses to cross the synaptic cleft are neurotransmitters. The neuron generating the original impulse is called the presynaptic neuron.

The primary action of digoxin is?

Increase in the force of the heart's contraction--positive inotropic effect

Over use of laxatives can cause?

Chronic constipation

What is inflammation?

Defense mechanism in response to many different stimuli, including physical injury, exposure to toxic chemicals, extreme heat, invading microorganisms, or death of cells

What is the antidote for digoxin toxicity?

Digoxin immune Fab (Ovine)

What medication are often the first choice treatment for HTN?

Diuretics

What are the pregnancy categories?

Drugs are placed into one of five pregnancy categories: A, B, C, D, and X •Drugs in category A are the safest •Those in category X are the most harmful--animal and human studies that show fetal abnormalities. The drug is contraindicated in women who are or may become pregnant. Reliable pregnancy prevention measures must be followed. •Although testing is done on animals it cannot be said with certainty that the drug is safe due to results varying from species to species. So caution should always be encouraged.

What is an antagonist?

Drugs that inhibit or block the responses of natural substances

What are risks for toxicity in medication administration for elderly patients?

Due to age elderly clients are at risk for an increase in drug toxicity due to: •Increased body fat •Reduced plasma level -therapeutic response is diminished •Less body water -Older adults have less body water, making the effects of dehydration more dramatic and increasing the risk for drug toxicity. •Liver produces less albumin: -Decreased plasma protein-binding ability -Increased levels of free drugs ▪Increases potential for drug-drug interaction •Decreased cardiac output -Less efficient blood circulation -Pharmacotherapy should be initiated with smaller dosages and slowly increase the amount to a safe, effective level.

What does bacteriocidal mean?

Having the capability to kill bacteria.

What is important information to give to patients regarding herbal preparations and prescription medications that the patient should be made aware of?

Herbs may actually contain dozens of active chemicals, not just one. · Unlike prescription drugs, the active ingredients in an herb may be present in just one part or many parts. · Most herbs have not been standardized and are not regulated by the Food and Drug Administration (FDA). · Herbs are not necessarily safer than prescription medications; they are medications · Herbal preparations are nonprescription drugs that have side effects and can interact with many other drugs. · Herbal products are not regulated by the Food and Drug Administration (FDA) for safety standards. They are regulated by a far less rigorous law, the Dietary Supplement Health and Education Act (DSHEA) of 1994, which does not require the manufacturer to demonstrate efficacy or safety of the herbal product.

What is the MOST common adverse effects of diuretic therapy?

Hypotension, dizziness, and fainting can result from the rapid fluid loss--diuretics can produce dehydration and electrolyte imbalances. Signs of dehydration include thirst, dry mouth, weight loss, and headache.

Why are intranasal corticosteroids considered safer than systemic corticosteroids?

Intranasal corticosteroids produce none of the potentially serious adverse effects that are observed when these medications are given orally

What is naloxone used for?

It is used for complete or partial reversal of opioid effects in emergency situations when acute opioid overdose is suspected

furosemide is what class of medication?

Loop diuretic--potassium depleting

What is an adverse effect of long term use of Proton Pump Inhibitors (PPIs)?

May interfere with calcium absorption and cause osteoporosis and fracture

How does morphine decrease pain?

Morphine binds with both mu and kappa receptors to produce profound analgesia

What drugs are most effective for treating severe diarrhea?

Opioids are the most effective drugs for relieving severe diarrhea--diphenoxylate (Lomotil), Loperamide (Imodium)

What are contraindications of dantrolene?

Patients with impaired cardiac or pulmonary function or hepatic disease should not take this drug.

What is pharmacokinetic and what are the four major components of pharmacokinetics?

Pharmacokinetics focuses on what the body does to the drugs. •Focuses on four processes •Absorption-How drugs are transported throughout the body •Distribution-How drugs are transported throughout the body •Metabolism-How drugs are converted to a form that is easily removed from the body. •Excretion-How drugs are removed from the body

spironolactone (Aldactone) is what type of diuretic

Potassium sparing

What is the difference between potency and efficacy?

Potency refers to a drug's strength at a certain concentration or dose. •Higher potency=smaller dose •Ex: Morphine is more potent than codeine; a lesser dose will be required. •Efficacy refers to the ability of a drug to produce a more intense response as its concentration is increased

Vitamin deficiencies may be caused by?

Poverty fad diets chronic alcoholism prolonged parenteral feeding

What is methadone used for and how does it work?

Primarily used for heroin or other opioid dependence. It is an opioid but does not produce the same degree of euphoria as heroin -Does not cure the dependence, and the patient must continue taking the drug to avoid withdrawal symptoms.

Why are inhaled forms of a beta-adrenergic stimulators (albuterol) preferred over oral forms?

Rapid response--The respiratory system offers a rapid and efficient mechanism for absorbing prescriptions. The enormous surface area of the bronchioles and alveoli, and the rich blood supply to these areas, results in an almost instantaneous onset of action for inhaled substances.

What is a superinfection?

Secondary infections that occur when microorganisms normally present (normal flora) in the body are killed by a drug

How are buccal medications administered?

See image

Know conversions

See image

Know medical abbreviations

See image

What is serotonin syndrome and what causes it?

Serotonin syndrome is a potentially life-threatening reaction when taking too-high doses of SSRIs or taking SSRIs with other antianxiety or anti-depressive drugs, including herbal drugs, that increase serotonin levels.

Bacteria are described and classified by what methods?

Staining-Gram-positive or gram-negative Shape-Bacilli (rods), cocci (spheres), and spirilla (spirals) Ability to use oxygen -Aerobic—uses oxygen or anaerobic—without oxygen

What does bacteriostatic mean?

The ability to slow growth of bacteria

How should a patient be instructed to take potassium supplements (KCL)?

The drug should be taken with meals or antacids to lessen the gastric distress

How can the nurse evaluate medication effectiveness?

The evaluation of effectiveness of pharmacotherapy includes measurable improvement in clinical signs and symptoms, vital signs and/or laboratory values.

What is a priority nursing assessment for all patients prescribed antidepressants?

The nurse should always assess for suicidal ideations in any depressed patient who is about to begin antidepressant therapy because these medications can take several weeks before full benefits are obtained.

What is the nurse's priority assessment when administering IV diazepam (Valium)?

The nurse should perform frequent assessments for level of consciousness (LOC), respirations, and oxygen levels because respiratory depression is common when administering diazepam IV

What can occur if a patient takes phenelzine/Nardil, an MAOI, with medications or food that can cause a drug interaction?

This can cause a hypertensive crisis which can result from interaction between M A O I s and foods containing tyramine See image

Why should potassium rich foods and potassium supplements be avoided when taking potassium sparing diuretics?

This would place the patient at risk for hyperkalemia

What is the purpose of thrombolytic medications?

To dissolve life-threatening clots

How should the nurse instruct a patient prescribed pancreatic enzymes to take them?

To take with meals--administration of these drugs are timed to coincide with meals so that the enzymes are available when food reaches the duodenum

What is the nurse's priority assessment before applying topical medications?

Topical medications are applied locally to the skin therefore, the nurse should assess the integrity of the skin where the medication is to be applied--if the skin is cracked, dry or irritated the medication may not absorb properly

What is the antidote for warfarin?

Vitamin K

What are the s/s of left sided heart failure?

fatigue, tachycardia, dyspnea, (left = lungs), pulmonary congestion, crackles ect..

What is a teratogen?

an agent or factor that causes malformation of an embryo during any stage of pregnancy

Patient who are prescribed antiplatelet therapy (clopidogrel/Plavix) should be cautious of which drugs that will increase the risk of bleeding?

anticoagulants, other antiplatelet drugs, thrombolytic agents or NSAIDS

What is the most common cause of low B12 levels?

lack of intrinsic factor (allows B12 to be absorbed from the intestine)

What are the s/s of hyperthyroidism (grave's disease)?

nervousness, tremors, irritability, insomnia, high body temperature (hyperthermia), tachycardia, palpitations, weight loss, bulging eyes (exophthalmos), and heat intolerance

What are the s/s of right sided heart failure?

peripheral edema (lower extremities), ascites, weight gain, Jugular vein distention (JVD)

What is the purpose of anticoagulant medications?

prevent excessive clotting by interfering with coagulation cascade

What is dantrolene/Dantrium used for?

relieves spasticity by interfering with the release of calcium ions in skeletal muscle

Know medical abbreviations (cont)

see image

Thrombolytic agents must be administered within what time frame to be effective in treating a thrombolytic CVA?

within 3 hours

What education should the nurse provide for patients taking anti-seizure medications?

•Never abruptly stop taking anti-seizure medication; doing so can cause seizures to return. •Avoid alcohol and other CNS depressants because they can increase sedation. •Anti-seizure medications may cause drowsiness; avoid driving and the use of machinery that could lead to injury. •It may require several dosage adjustments over many months to find the dosage that allows performance of normal daily activities while controlling seizures. •It is important to keep laboratory appointments because many anti-seizure medications require blood testing (CBC, renal, and liver function) to ensure that the drug is at a safe and effective level in the blood. •Anti-seizure medication may reduce effectiveness of birth control. •Consult a healthcare provider before trying to become pregnant; some anti-seizure medications are not safe to use during pregnancy. •Report excess fatigue, drowsiness, agitation, confusion, or suicidal thoughts to a healthcare provider •Notify provider with weight loss or gain

What information should be given to a patient when educating them on the use of albuterol?

•Allow an interval of at least 1 minute to pass between puffs. •When taking more than one respiratory medicine, take the bronchodilator first. This opens the airways and increases the effectiveness of the second medication. •Rinse the mouth thoroughly following inhaler use to reduce the oral absorption of inhaled medicines. •Use 15 to 30 minutes prior to physical activity, to prevent exercise-induced bronchospasms

What are s/s of bipolar disorder?

•Characterized by extreme and opposite moods •Patient may show signs of euphoria and depression or feelings of excitement and calm •Depression (dysphoric) signs and symptoms the same as major depression •Symptoms of mania •Disordered sleep patterns •Activity for days without rest and without appearing tired •Easy agitation and aggression •Feelings of exaggerated confidence •Making choices without regard for a long-term plan or consequences of action •Attention seeking •Unusual interest in sex •Drug abuse, including alcohol, cocaine, or sleeping medications •Denial that the behavior is a problem—makes compliance difficult

What is viral load and what is the importance of assessing viral load in patients receiving antiviral treatment?

•Determined by measuring the amount of HIV RNA in the blood. •The most important indicator of how the virus is replicating in the body. •After the initial measurement, viral load is measured regularly to determine the effectiveness of pharmacotherapy

What is psychosis and what are causes of psychosis?

•Disruptions to a person's thoughts and perceptions that make it difficult for them to recognize what is real and what isn't and can by caused by many factors including: genetics, trauma, physical illness or injury, trauma, abuse of illicit drugs (marijuana, LSD, amphetamines, etc..), and mental illnesses caused by abnormal levels of neurotransmitters in the brain such as schizophrenia, depression, and bipolar disorder

What is an agonist?

•Drugs capable of binding with receptors and causing a cellular response/action

What are antitussive medications?

•Drugs used to suppress cough

What treatment would be used for mild inflammation?

•For mild symptoms, nonpharmacologic therapies such as ice packs, rest, compression (if indicated) and elevating affected extremity should be used, as appropriate for condition and nonsteroidal Anti-inflammatory Drugs (NSAIDs)

What are nursing considerations for the administration of tamoxifen?

•Give with food or fluids to decrease G I irritation. •Do not crush or chew drug. •Avoid antacids for 1-2 h following P O dosage of tamoxifen. •Assess for hypercalcemia

What are nursing considerations for the administration of amphotericin B (Fungizone)?

•Given IV and should be infused slowly because cardiovascular collapse may result if the medication is infused too rapidly. •Administer premedication, such as acetaminophen, antihistamines, and corticosteroids, to decrease the risk of hypersensitivity reactions. •Withhold the drug if the blood urea nitrogen (B U N) exceeds 40 m g/d L or serum creatinine rises above 3 m g/d L. Pregnancy category B.

Diuretics are used to treat what conditions?

•Hypertension •Heart failure •Kidney failure •Pulmonary edema •Liver failure or cirrhosis

What are adverse effects of cholinergic drugs (parasympathomimetics)?

•Increased salivation, sweating, abdominal cramping, and hypotension that can lead to fainting • These drugs should not be given to patients with suspected urinary retention (BPH) or intestinal obstruction or those with active asthma

What is benztropine (Cogentin) used for and what are the adverse effects that the nurse would need to monitor for when giving this drug?

•It is used for relief of parkinsonism symptoms and for the treatment of EPS brought on by antipsychotic pharmacotherapy •Can cause typical anticholinergic adverse effects such as sedation, dry mouth, constipation, and tachycardia

What are ways a nurse can prevent medication errors?

•Positively identify the identity of each patient every time! •Patient identifiers—Name and DOB •Always ask the patient about allergies to food or medications •AVOID DISTRACTIONS—DO NOT MULTITASK DURING PREPERATION OF MEDICATIONS—QUIET ENVIRONMENT IS BEST •Practice the 6 rights of medication administration and the 3 Ps •Check drug calculations and measure medication doses carefully. •Never administer a medication without being familiar with its uses and side effects. •Properly document the medication administration process according to institutional policy.

Beta 2 agonist drugs effect what organs?

•Relax smooth muscles which include all sympathetic target organs except the heart •Responses-inhibition of smooth muscle contractions •ex- Albuterol-dilates bronchial airways by relaxing the muscles that surround the airways

What are symptoms of Generalized Anxiety disorder (GAD)?

•Restlessness, fatigue, muscle tension, nervousness, inability to focus or concentrate, an overwhelming sense of dread, and sleep disturbances

What are extrapyramidal adverse effects (E P S)?

•Serious set of adverse reactions to antipsychotic drugs •E P S include: •Acute dystonias •Involve severe muscle spasms, particularly of the back, neck, tongue, and face •Occur early in the course of pharmacotherapy •benztropine/Cogentin use to treat—given parenterally •Akathisia •Most common E P S •Inability to rest or relax •Patient paces, trouble sitting still, and sleeping •Beta blockers and benzodiazepines to reduce symptoms •Secondary (induced) parkinsonism •Tremor, muscle rigidity, stooped posture, bradykinesia, and shuffling gait •Tardive dyskinesia •Long term use •Unusual tongue and facial movements, including lip smacking

What are common adverse effects of SSRIs?

•Sexual dysfunction--Females--decreased libido and lack of ability to reach orgasm; Males―delayed ejaculation and impotence •Weight gain •Nausea •Headache •Anxiety •Insomnia

What are the positive symptoms of schizophrenia?

•Symptoms that add on to normal behavior •Hallucinations, delusions, or paranoia •Strange behavior, such as talking in rambling statements or making up words—disorganized speech •Strange or irrational actions •Changes from stupor to extreme hyperactivity (catatonic/disorganized behavior)

What are the negative symptoms of schizophrenia?

•Symptoms that takeaway from normal behaviour •Attitude of indifference toward or detachment from life activities •Neglect of personal hygiene, job, and school •Noticeable withdrawal from social activities and relationships •Changes from extreme hyperactivity to stupor

How should a patient be instructed to take levodopa-carbidopa?

•Take levodopa-carbidopa at least 30-60 minutes before eating in order to allow the medication to be absorbed before food can interfere. Do not take with foods that contain protein, as these foods can decrease drug effectiveness

What medication class is considered first line treatment for Alzheimer disease?

•The acetylcholinesterase (AChE) inhibitors are the most widely used class of drugs for treating AD

How are peptic ulcers caused by H pylori most commonly treated?

•The most common therapy for the management of PUD is a combination of a PPI plus two antibiotics ••Eliminates the cause of most peptic ulcers (H. pylori) while also reducing acid secretion •Increases the effectiveness of therapy and lowers the potential for bacterial resistance

When educating patients about medications what essential information should the nurse teach patients about their medications?

•The names of all medications they are taking, the uses, the doses, and when and how they should be taken •The medications' adverse effects, especially those that need to be reported immediately

Why is it important for the nurse to assess kidney and liver functions when administering medications?

•The nurse should be aware of impairments of the kidneys or liver, because this can affect pharmacotherapy and can cause overdose or toxicity for patient's who are in renal or hepatic failure

What is the therapeutic level for lithium?

•To ensure therapeutic action, concentrations of lithium in the blood must remain within the range of 0.6 to 1.5 mEq/L •Close monitoring encourages compliance and helps to avoid toxicity •Mild Toxicity: nausea, vomiting, lethargy, tremor, and fatigue (Serum lithium concentration between 1.5-2.5 mEq/L) •Moderate Toxicity: confusion, agitation, delirium, tachycardia, and hypertonia (serum lithium concentration between 2.5-3.5 mEq/L) •Severe Toxicity: Coma, seizures, hyperthermia, and hypotension (serum lithium concentration (3.5 mEq/L or greater)

What is a live attenuated vaccine and what is an example of one?

•Vaccines which contain microbes that are alive but weakened so they are unable to produce disease. •Example: measles, mumps, and rubella (MMR) vaccine

What information concerning diuretics should the nurse be aware of?

•diuretics can cause electrolyte imbalances--be aware of the type of diuretic the patient is on--potassium sparing or potassium depleting (loop and thiazide)--monitor laboratory findings, especially potassium and sodium •diuretics reduce blood volume, resulting in lowered blood pressure--monitor vital signs, especially blood pressure

What medication can be given to reverse a patient who is in acidosis?

•sodium bicarbonate—bicarbonate ion acts as a base to quickly neutralize acids in the blood and other body fluids.