NUR 106 Pharmacology Exam 1
Adverse effects of H2 blockers
-Nausea and vomiting -Constipation and diarrhea -Abdominal pain -Cognitive Impairment -Increased bacterial growth -Osteoporosis (not getting enough calcium: decreases stomach's ability to absorb calcium)
Non pharmacological treatment of GERD
1) Avoid alcohol and smoking 2) Limit or avoid caffeine 3) Avoid NSAIDS 4) Change diet patterns 5) Avoid eating 3 hours prior to bedtime 6) Raise head of bed 6-12in 7) Eat 5-6 small meals a day instead of 3 large meals
Why should you not put children under 18 on fluoroquinolones?
Bone cartilage hasn't fully developed, so makes tendon rupture easier
What is the function of stomach acid in the body?
Breaks down food and kills invaders
Actions of Penicillin
Broad Spectrum Antibiotic Interferes with cell wall synthesis Treats: pneumonia, meningitis, ear and throat infections
Actions of Tretracyclines
Broad spectrum antibiotics; inhibit protein synthesis Treats: RSMF, Lyme disease, H.pylori, Chlamidia, and Acne
Side effects of salicylates
Gastric distress (nausea, vomiting, anorexia) Prolonged Bleeding (decreases platelet aggregation) Lack of urination
Which name(s) of drug should the nurse use when teaching a patient with a new prescription?
Generic and trade name
PRN Orders
Given on an "as needed" basis (i.e. nausea, pain)
Diarrhea
Having at least 3 loose/watery/liquid bowel movements a day
What is the function of enzymes in the stomach?
Help break down proteins and lipids (chemical digestion)
Adverse effects of Flagyl
High doses produce neurotoxicity
How do H2 blockers block stomach acid production?
Histamine blockers (H2 Blockers) compete for binding sites
How does pregnancy make women more at risk for GERD (acid-reflux)?
Hormones and growing fetus putting pressure on the abdomen
Allergic reaction
Hyper response of body's defenses/An exaggerated immune response
Averse Reactions from penicillin
Hypersensitivity leading to anaphylaxis
What infections typically cause diarrhea?
IBD and IBS
How does Reglan work?
Increases peristalsis and GI activity
Actions: Sulfonamides
Inhibits synthesis of folic acid (which is essential to organism's growth) Primarily treats UTIs, and acute Otis media in children
Subcutaneous Injection
Injection into the subcutaneous tissue that lies between the epidermis and the muscle
Actions of fluroquinolones
Interferes with DNA synthesis—leading to cell death. Treats: Respiratory tract infections, UTIs, Otitis media, and ANTHRAX
Anti-Fungal medication actions
Interrupts integrity of cell walls—"leaky walls"
The parenteral route includes
Intradermal (ID), Subcutaneous (SC), Intramuscular (IM), Intravenous (IV)
Examples of Anti-Tubercular Meds
Isoniazid (INH) Rifampin
What are some things you should consider when taking or administering penicillin?
It decreases the effectiveness of oral contraceptives
What are some things you should consider when taking or administering Vancomycin?
It is highly toxic: May cause ototoxicity or permanent hearing loss Peak and troughs drawn due to toxicity
Why should you not take sulfanomides with alcohol?
It may cause an antabuse type reaction
Constipation Risk Factors
Lack of physical activity Insufficient dietary fiber Medications (ex: opioids) Certain foods (Dairy/ETOH) Hypothyroidism/DM/IBS Elderly
Actions: Cephalosporins
Largest antibiotic class Inhibits cell wall synthesis Treats: MRSA, upper and lower respiratory infection, skin and sinus infections Broad Spectrum
risk factors of peptic ulcer disease
Lifestyle Gender H.Pylori infection Age Genetic Factors Stress Drugs (NSAIDS)
Nonpharmaceutical Treatments for Constipation
Lifestyle measures (Exercise, fiber, drink more fluids)
5 Categories of Laxatives: Stool Softener
Lower surface tension Take with full glass of water Takes several days to produce stool
What does vancomycin administered through IV typically treat?
MRSA and Septicemia
Anti-infective medications
Medications that are effective against pathogens (may treat viral, fungal, bacterial, or parasitic infections)
What do aminoglycosides treat?
Meningitis Septicemia UTI Eye Infection MRSA
Example of protozoal infection medication
Metronidazole (Flagyl)
What should health care professionals monitor when treating patients taking Aminoglycosides?
Monitor for peak and trough levels to prevent serious adverse effects.
What should you monitor in a patient taking Amphotericin B?
Monitor urine output
What drugs can make someone more at risk for peptic ulcer disease?
NSAIDS
Example of Naloxone
Narcan
Adverse effects of taking anti-tubercular meds
Neuropathy (numbness of hands and feet) Hepatotoxicity (jaundice), anaphylaxis Photosensitivity (use sunblock)
NSAIDS Acronym
No alcohol Salt and fluid retention Acute kidney failure Inhibits prostaglandins Do take with food Stop 1 week prior to surgery
Example of Anti-Fungal medications
Nystatin (Myostatin) Amphotericin B
Serotonin Antagonists (Nausea and Vomiting)
Odansetron (Zofran) Dolasetron (Anzemet) Adverse effects: H/A, constipation, diarrhea
Examples of proton pump inhibitors ("prazole")
Omeprazole (Prilosec) Lansoprazole (Prevacid) Pantoprazole (Protonix) Esomeprazole (Nexium)
Routine Orders
Ordered routinely (i.e. twice a day, once a day)
5 Categories of Laxatives: Saline
Osmotic; pulls water in to soften hard stool Clean out for colonoscopy MiraLax
Adverse reactions of aminoglycosides
Ototoxicity (loss of hearing) Nephrotoxicity (reduced kidney function) Neurotoxicity (seizures)
Peak vs. Trough
Peak: Greatest concentration of medication in blood 30 min after infusion Trough: Greatest concentration of drug in tissues 30 min prior to next infusion
Examples of Penicillin
Penicillin G Ampicillin Piperacillin
Side effects of Narcan (5 P's)
Perspiration Increased Pulse Increased Pressure (BP) Increased Pain Puke
Example of saline laxative
Polyethylene Glycol (MiraLax)
When do you perform a culture and sensitivity?
Prior to administering an antibiotic
Phenothiazines (Nausea and Vomiting)
Prochlorperazine (Compazine) Promethazine (Phenergan) Use with caution in elderly
What is the function of mucous in the stomach?
Protects the lining of the stomach from being eaten away by the acid
What is an example of a bulk-forming laxative?
Psyillium Mucilloid (Metamucil)
What do tetracyclines treat?
RSMF, Lyme disease, H.pylori, Chlamidia, and Acne
Examples of H2 Blockers ("dines")
Ranitidine (Zantac) Famotidine (Pepcid) Nizatidine (Axid) Cimetidine (Tagamet)
What is the function of the large intestine?
Reabsorbs water and excretes fecal material
NSAID Actions
Reduces inflammatory process to relieve pain by creating a shield against Cox-1 and Cox-2 enzymes which cause inflammation
Side effects of opioid analgesics
Respiratory depression Decreased BP Constipation Urinary Retention Blurred Vision Dependence
What do fluoroquinolones treat?
Respiratory tract infections UTIs Otitis media ANTHRAX
Side effects of penicillin
Safest class (minor side effects) Allergy Gastric Distress Diarrhea
5 Categories of Laxatives: Bulk-forming (Metamucil)
Semi-synthetic polysaccharide Forms gel in stomach Softens fecal matter and increases bulk, stretches wall (1-3 days to produce poop)
Example of Herbal Laxative
Senna (Ex-Lax)
What two classes of drugs can be used for nausea and vomiting?
Serotonin antagonists Phenothiazines
Anaphylaxis
Severe allergic reaction
ASAP Order
Should be available for administration to the patient within 30 minutes of the written order
How can lifestyle make you more at risk for peptic ulcer disease?
Smoking Acidic Drinks Medications
5 Categories of Laxatives: Stimulant
Stimulates motility Increase water in intestines Works in 6-12 hours (but can work in 20 min) Suppository
Anti-diarrheals
Stops further occurrence of diarrhea
Sulfanomides: S.U.L.F.A acronym
Sunlight sensitivity-sunburn Undesireable-Nausea, vomiting, fever, rash Look for sore throat, fever, yellow skin or eyes Fluids galore (prevent crystalluria) Anemia (lack of folic acid)
Adverse reactions from tetracyclines
Suprainfections and liver toxicity
What do proton pump inhibitors do?
Supress gastric acid production
What is the Anti-fungal Amphotericin B used to treat?
Systemic fungal infections
What are some things you should do when taking tetracyclines?
Take full glass of water; empty stomach (1hr before or 2 hrs after meals) Don't take with milk or antacids (interacts with calcium)
What are some things you should consider when taking or administering a macrolide?
Take on empty stomach (food delays absorption) If GI symptoms occur, give with food Avoid taking with magnesium or aluminum containing antacids Don't give to elderly or heart disease patients Fruit juice reduces action
Things to consider when taking or administering NSAIDS
Take with food or milk to decrease gastric upset Use with caution in known kidney and liver disorders Do not use in patients with preexisting heart disease Do not use in patients taking anticoagulant therapy Do not use in children with viral disorders [NSAIDS ACRONYM] No alcohol Salt and fluid retention Acute kidney failure Inhibits prostaglandins Do take with food Stop 1 week prior to surgery
Examples of Tetracyclines
Tetracycline (Sumycin) Doxycycline (Vibramycin)
intramuscular injection
The administration of medication by injection directly into muscle tissue
Intradermal Injection/ID
The administration of medication by injection into the middle layers of the skin
Where does the most nutrient absorption occur in the small intestine?
The jejunum
What do Sucralfates (Carafate) do?
They are a protective barrier against acid
What is the anti-fungal Nystatin used to treat?
Tinea Pedis (AKA athletes foot) Oral Candida (Thrush) --"Swish and Swallow Suspension"
Single Orders
To be given one time at a specific time
Why might a doctor prescribe flagyl to a patient before and after surgery?
To prevent infections of the intestines before and after surgery
Examples of Aminoglycosides
Tobramycin Amikacin Neomycin Gentamycin (T.A.N.G)
Topical Routes of Administration
Transdermal Opthalmic Optic Nasal Respiratory or Urinary Tract (Inhalation) Vaginal Rectal inhalation
Pharmacokinetics: Distribution
Transfer from one location to another
Actions of Anti-tubercular meds
Treats latent or active tuberculosis
T/F Antacids are for short-term relief. They do not correct any underlying problems.
True
T/F Lomotil is by prescription only
True
T/F The anti-tubercular medication, rifampin, often turns urine, sweat, and tears a red-orange color
True
T/F opioids help with constipation
True
T/F: You should take fluoroquinolones with food
True
Sulfanomides are typically used to treat:
UTIs and acute Otis media in children
Adverse events or effects
Undesired effects that may occur with use of the drug
What is the name of the council that adopts generic names for drugs?
United States Adopted Names Council
Example of Antibacterial Drug
Vancomycin (Vancocin)
What do Macrolides treat?
Whooping cough (pertussis) Diptheria Chlamydia Sinusitis, tonsillitis, pharyngitis
Intravenous
Within a vein
brand-name
a drug with a registered name or trademark given to a drug by a pharmaceutical company
Constipation
infrequent bowel movements
Bacteriostatic
inhibits bacterial growth
Examples of Sulfonamides
sulfamethoxazole/trimethoprim (TMP-SMX)
Parts of the small intestine
duodenum, jejunum, ileum Most nutrient absorption in the jejunum
STAT Order
single order carried out immediately
Actions of Aminoglycosides
Bactericidal; inhibits protein synthesis Treats meningitis, septicemia, UTI, Eye Infection, MRSA
Antibiotics are either _____ or _____.
Bacteriocidal or Bacteriostatic
Examples of anti-diarrheals
Bismuth Salts (Pepto Bismol) Ioperamide (Imodium) Diphinoxylate with atropine (Lomotil)
T/F Stress can cause peptic ulcer disease.
False Stress cannot cause it, but it can worsen
T/F When treating a patient with tuberculosis you should either use rifampin or isoniazid. Not both.
False Use both medications TOGETHER
T/F If taking a sulfanomide you can still continue to take oral contraceptives
False You need to use an alternative form of contraception
Side effects of Vancomycin
Fever/Chills Low BP Rapid Heartbeat
What are some actions of Opioid Analgesis?
First line drug for severe/extreme pain Natural or Synthetic Inhibits pain: Brain, Spinal Cord, Periphery
When should you NOT use an antidiarrheal?
For C.diff
What are proton pump inhibitors used for?
GERD, Ulcers, Heartburn
Side effects of macrolides
GI Upset IV site irritation
4 phases of pharmacokinetics
1. Absorption 2. Distribution 3. Metabolism 4. Excretion
5 Categories of Laxatives
1. Bulk-Forming 2. Saline 3. Stimulant 4.Stool softener 5.Herbal
What are some examples of antacids?
1. Calcium Carbonate (Tums) 2. Aluminum Hydroxide (Alterna Gel) 3. Calcium Carbonate with Magnesium (Rolaids) 4. Magnesium Hydroxide (Milk of Magnesia) 5. Magnesium hydroxide with aluminum and simethicone (Maalox; Mylanta)
"5 rights" of drug administration ("TRAMP")
1. Right Time 2. Right Route 3. Right Amount (Dose) 4. Right Medication/Drug 5. Right Patient
Type of Medication Orders
1. STAT Orders 2. ASAP Orders 3. Single Orders 4. PRN Orders 5. Routine Orders
How many min prior to a meal should you take proton pump inhibitors?
20-30 min
How many years on average does it take for a drug to be brought to market from the time of its conception?
8 to 15
What are some things you should consider when taking or administering anti-tubercular medications?
ALCOHOL is a contradiction Use both medications TOGETHER Mycobacterium tuberculosis resistant to anti-infectives • Multiple drugs given concurrently • Therapy continues for 6-12 months
Examples of NSAIDS (5)
Acetylsalicylic acid Ibubrofen Celecoxib Indomethacin Ketorolac
Nonpharmacologic Pain Management
Acupuncture Biofeedback therapy Massage Heat or cold packs Meditation Relaxation therapy Art or music therapy Physical Therapy Nerve Stimulator (TENS)
When is Reglan administered?
After surgery
Anitubercular contraindication
Alcohol
What should you avoid when taking Flagyl?
Alcohol
Pharmacokinetics: Metabolism
Alteration of a Substance (breakdown)
Actions of Macrolides
Alternative to penicillin, interferes with replication of bacteria Treats: whooping cough (pertussis) Diptheria Chlamydia Sinusitis, tonsillitis, pharyngitis
Adverse effects of Amphotericin B
Amphotericin B highly toxic—may cause nephrotoxicity and electrolyte imbalance. Monitor urine output
Salicylate Actions
Analgesic: management of pain Anti-inflammatory action: inhibit synthesis of prostaglandins Anti-pyretic: Lower Body temp
Adverse reactions of macrolides
Anaphylaxis Ototoxicity Dysrhythmia
Side effects of Tetracyclines
GI Upset Sun sensitivity (wear sunscreen)
Anti-infectives are most commonly referred to as:
Antibiotics
Example of Salicylate
Aspirin
How many mL of water should you drink per day while taking sulfanomides?
At least 2500-3000 mL
What are some things you should avoid when taking or administering fluoroquinolones?
Avoid antacids, calcium, multivitamins, iron or zinc (they decrease absorption) DO NOT use on children <18 years old (Bone cartilage development)
A nurse is teaching a client who has a new prescription for ciprofloxacin (Cipro) to treat a UTI. Which of the following instructions should the nurse include? A) "Take this medication with an antacid" B) "Monitor for tendon pain" C) "Drink 1,000 mL of fluid daily to reduce the risk of crystals." D) "Expect urine to turn a dark orange."
B) "Monitor for tendon pain"
When antibacterials are prescribed for the treatment of an infection and a culture is ordered, what should happen next? A) The initial dose of the antibiotic should be given before the culture is taken. B) The culture should be taken before the initial dose of the antibiotic is given. C) The culture should be taken any time after the antibiotic therapy begins. D) The culture may be taken at any time before or during antibiotic therapy.
B) The culture should be taken before the initial dose of the antibiotic is given.
An adolescent client is ordered to take tetracycline. Which of the following Instructions should be given to the client by the nurse? A) Take the medication on a full stomach or with a full glass of milk B) Wear sunscreen and a hat when outdoors C) Continue taking the medication until you feel better D) Avoid the use of soaps or detergents while taking this medication
B) Wear sunscreen and a hat when outdoors
A nurse is educating a client who has a new prescription for azithromycin (Zithromax) to treat pharyngitis. Which of the following statements by the client indicates understanding of the teaching? A) "I will take this medication until my sore throat goes away." B) "I should take this medication on an empty stomach." C) "I will stop taking this medication if I develop itching." D) "I will double my dose if I miss one."
C) "I will stop taking this medication if I develop itching."
A nurse is caring for a child who is allergic to penicillin. The nurse should verify which of the following prescriptions with the provider? A) Gentamycin B) Erythromycin C) Amoxicillin D) Amphotericin B
C) Amoxicillin
When caring for a patient with abnormal functioning of hepatic enzymes, the nurse is most concerned with monitoring for signs of change in which aspect of pharmokinetics? A) Absorption B) Distribution C) Metabolism D) Excretion
C) Metabolism
A client has been receiving cephalosporins for 3 weeks to treat a severe bacterial infection. The client complains of mouth pain, and the nurse assesses white patches in the patient's mouth. What is the highest priority action on the part of the nurse? A) Provide mouth care with glycerin swab B) Encourage the client to drink more fluids C) Notify the physician and describe the symptoms D) Administer analgesic for the mouth pain
C) Notify the physician and describe the symptoms
What does Flagyl treat?
C-difficile H. Pylori Vaginitis Rosacea
Side effects of fluoroquinolones
GI distress Photo-sensitivity (sunburn despite use of sunscreen)
Side effects of Flagyl
GI upset Diarrhea Headach Darkening of urine
What does vancomycin administered orally typically treat?
C.diff
Examples of Cephalosporins
Cephalexin Cefazolin Cefapime
Examples of Fluroquinolones
Ciprofloxacin (Cipro) Levofloxacin (Levaquin)
Opioid Analgesic Examples (6)
Codeine Hydromorphone (Dilaudid) Oxycodone (OxyContin, Percocet) Hydrocodone (Vicodin) Meperidine (Demerol) Fentanyl (Duragesic)
Which of the following statements is true when educating clients about penicillin therapy? A) The client must take the medication at evenly spaced intervals B) The client may save leftover medication for future illnesses C) If signs of an allergic reaction, continue the medication and notify the provider D) Clients taking oral contraceptives must use an alternate form of birth control
D) Clients taking oral contraceptives must use an alternate form of birth control
Side effects of cephalosporins
GI upset, diarrhea (typically bloody), rash, bleeding Serious side effects: Anaphylaxis
Side Effects of NSAIDS
Gastric Distress Heartburn Bleeding Tinnitus Rash
How does lomotil and immodium work?
Decrease muscle contraction and movement
chemical name of drug
Describes the drug's chemical composition and molecular structure
Actions of Flagyl
Disrupts DNA inside cell interfering with replication of parasites Treats c-difficile, H. Pylori, Vaginitis, and Rosacea Prevent infections of the intestines before and after surgery
Sulfanomide Considerations
Do NOT take with alcohol (may cause antabuse type reaction) Drink AT LEAST 2500-3000 mL of water per day during therapy Take one hour before or 2 hours after food Antacids decrease absorption Use alternate form of contraception
Reglan - Nausea
Dopamine antagonist Used to treat nausea and heartburn Increase peristalsis and GI activity Given after surgery
Adverse reactions of fluoroquinoloes
Dysrhythmias Hepatotoxicity Cartilage Toxicity: Tendon rupture
Narrow spectrum antibiotics
Effective against a smaller/more narrow group of bacteria Less side-effects
Broad spectrum antibiotics
Effective against a wide variety of organisms More side effects
Pharmacokinetics: Excretion
Elimination of drugs and metabolic waste from the body
What is Narcan used for?
Emergency overdose treatment
Examples of Macrolides
Erythromycin Azithromycin Clarithromycin
Example of a stimulant laxative
bisacodyl (Ducolax)
What do H2 blockers do?
block stomach acid production
How do sucralfates work?
coats stomach Protects 6-8 hours
Aluminum may cause
constipation
Magnesium may cause
diarrhea
Example of stool softener
docusate sodium (colace)
GERD
gastroesophageal reflux disease (acid reflux)
Bactericidal
kills bacteria
Pharmacokinetics: Drug Absorption
movement of drug from site of administration into the blood stream
generic name
name assigned by the manufacturer who first develops a drug (it is often derived from the chemical name)
What do antacids do?
neutralize stomach acid
Side effect
non-therapeutic reaction
United States Adopted Names Council
organization that adopts the generic name of a drug
Adverse Reactions of Vancomycin
ototoxicity nephrotoxicity "red man" syndrome
Nocioceptors
pain receptors
culture and sensitivity (C&S)
perform prior to antibiotic Identifies bacteria and antibiotic sensitivity Can be collected from sputum, blood, drainage, stool, spinal fluid, etc.
What does penicillin treat?
pneumonia, meningitis, ear and throat infections