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