Pharmacology Exam 1 Practice
Older Adult: Pharmacokinetic Alterations: Distribution
Decreased total body water increases concentration of med; risk toxicity Decreased protein (albumin); greater amount of free drug; risk toxicity
Xanthine derivatives Prototype: Theophylline/Aminophylline works by?
Direct effect on smooth muscles of the respiratory tract, both in bronchi & blood vessels (metabolized to caffeine)
A client is prescribed guaifenesin. What instructions should the nurse provide to the client?
Drink at least 2-3 liters of fluid daily.
A client is prescribed diphenhydramine. The nurse should monitor for what adverse effects?
Drowsiness and constipation
Older Adult: Pharmacokinetic Alterations: Metabolism
Enzyme activity decreased due to decreased function; increased risk toxicity
Which body function(s) is/are controlled by the autonomic nervous system?
GI Secretion, Urination, Body Temperature,Blood Pressure
The nurse is caring for client with a tracheostomy who has developed pneumonia. The client is having difficulty coughing up the thick, dry secretions associated with the infection. Which medication should the nurse administer to this client?
Guaifenesin
What is a peak drug level?
Highest level of the drug in the bloodstream drawn 1 hour after infusion.
The nurse is preparing to administer pseudoephedrine to a client. The nurse should monitor the client for which adverse effect?
Hypertension
What is the major anatomical site for integration of autonomic information?
Hypothalamus
The nurse is preparing to administer eyedrops to a client. Where should the nurse place the drop?
In the conjunctival sac
Older Adult: Pharmacokinetic Alterations: Gastrointestinal
Increased gastric pH and decreased peristalsis, Decreased absorption
How does grapefruit juice affect the hepatic enzyme system?
Inhibits the enzyme system
An example of an Agonist is?
Insulin; beta-agonist; Albuterol
The nurse knows that which route will result in 100 percent bioavailability?
Intravenous
A client is prescribed loratadine for seasonal allergies. The nurse knows this medication has what advantage over diphenhydramine in treating seasonal allergies?
It is less sedating than diphenhydramine.
A client has been advised to use oxymetazoline to treat symptoms of a common cold. Which instructions should the nurse include when educating the client?
Limit the use of this medication to 3-5 days.
A client is prescribed intranasal fluticasone. What information should the nurse include when teaching the client?
Long term use may result in breakdown of the nasal mucosa.
What is the trough drug level?
Lowest drug level needed to reach therapeutic range- drawn 1 hour prior to infusion.
Selective toxicity refers to:
•Ability of a drug to attack only those systems found in foreign cells
An example of Drug-Enzyme Interactions is:
•Angiotensin converting enzyme inhibitor (ACE-inhibitor) RASS system plays a part in this.
Beta2-adrenergic agonists (SABA) Prototype: albuterol MoA and indication?
MOA: Beta2 selective adrenergic agonist; bronchodilation Indications: Acute bronchospasm (asthma attack, COPD exacerbation, pneumonia); prevention of exercise-induced asthma NC: admin for symptoms or scheduled; overuse increases AE; use 30-60 min prior to exercise
Antagonist is?
•Competitive: Block normal stimulation of receptor •Noncompetitive: Prevent reaction of another chemical with a different receptor site on cell
CM of Antagonist (cholinergic-blocking)
•Decreases saliva/secretions •Increased heart rate •Relaxes bronchioles •Decreased GI motility and peristalsis •Urinary retention •Drowsiness, disorientation
CM of Agonist (cholinergic agonist)
•Increases saliva production •Slows heart rate •Constricts bronchioles •Stimulates digestive process •Increases urination
Drug-Enzyme Interactions refers to:
•Interferes with enzyme systems that act as catalysts for chemical reactions •One interruption (drug) in cascade can block the normal cell function
An example of Selective Toxicity is:
•Penicillin (antibiotic); chemotherapy drugs (goes for cancer cells)
Anticholinergics details:
•Substance that blocks neurotransmitter acetylcholine (Ach) (cholinergic) in CNS and PNS •Affect vagus nerve to relax bronchial smooth muscle and promote bronchodilation
Beta2-adrenergic agonists (LABA) Prototype: salmeterol (Serevent Diskus) MoA and indication?
MOA: Beta2 selective adrenergic agonist; bronchodilation Indications: prevent exercise-induced bronchospasm, COPD, asthma (maintenance) NOT a rescue inhaler; admin on schedule
Beta2-adrenergic agonists (Sympathomimetic) details:
Mimic effects of the sympathetic nervous system •Dilation of bronchi with increased rate and depth of respiration •Act on beta receptors
Respiratory anticholinergic Prototype: ipratropium (Atrovent) MoA and indication?
MoA: blocks acetylcholine; airway dilation Indication: Prevention of bronchospasm (maintenance) Not a rescue Inhaler
Which action by a student nurse who is giving a subcutaneous insulin injection requires the supervising nurse to intervene?
The syringe is aspirated before injecting.
What is a secondary reaction (side effects/adverse effects)
Undesired effects produced in addition to pharmacologic effect (ex - nausea)
The nurse is preparing to administer an antihistamine to a client. Which condition should the nurse assess for when considering the adverse effects of the medication?
Urinary retention
Theophylline/Aminophylline indications are?
prevention (Theophylline) or reversal of bronchospasm (Aminophylline) oral (theophylline) or IV (aminophylline)
What is pharmacodynamics?
what the drug does to the body •Drugs act at specific areas on cell membranes called receptor sites
An example of a Long-acting beta agonist (LABA) "maintenance inhaler"?
Salmeterol
How does Leukotriene receptor antagonist work?
Selectively block receptors for production of leukotrienes; reduces inflammation; reduces the symptoms of asthma
Sympathomimetics: Beta2-adrenergic agonists are divided into two classifications?
Short-acting beta agonist (SABA) "rescue inhaler" & Long-acting beta agonist (LABA) "maintenance inhaler"
A client is experiencing symptoms of the "fight-or-flight" response. Which autonomic process stimulates this response?
Sympathetic system
Long-acting beta agonist (LABA) "maintenance inhaler" Dose/Route?
1 inhalation every 12 hours (scheduled)
For both Bronchodilators and Corticosteroids, if using the same medication, you must wait how long between puffs of medication?
1 minute
Medications work in one of four ways:
1.To replace or act as substitutes for missing chemicals 2.To increase or stimulate certain cellular activities 3.To depress or slow cellular activities 4.To interfere with the functioning of foreign cells, such as invading microorganisms or neoplasms leading to cell death
A client is prescribed diphenhydramine 25 mg every 8 hours via a PEG tube. The medication is available as a 12.5 mg/5 mL syrup. How many milliliters (mL) should the nurse administered with each dose? Include only the number in your answer.
10
Short-acting beta agonist (SABA) "rescue inhaler" Dose/Route?
2 inhalations every 4-6 hours as needed
The nurse is preparing to administer metoprolol 50 mg orally to a client with hypertension. The medication is available in 25 mg tablets. How many tablets should the nurse administer?
2 tablets
A client is prescribed two different types of inhaled medications for treatment of chronic obstructive pulmonary disease. After administering the first medication, how long should the nurse wait to administer the second medication?
5 minutes
Agonist is?
A chemical that mimics the action of a neurotransmitter. Cause same activity of natural chemicals would cause at that site
Pregnancy Categories Listed:
A- Safe/adequate studies humans; no evidence of risk B- Problems in Animals, unknown in Humans C- studied in animals; reveal adverse effects D- studies confirm fetal risk; benefits > risk X- observation or studies fetal abnormalities
The nurse is preparing to administer the first dose of a medication to a client. The nurse should prioritize monitoring for which potential effect?
Anaphylaxis
Inhaled corticosteroid Prototype: fluticasone (Flovent) MoA and indication?
Actions: Decrease inflammatory response in airways Indications: Prevention and treatment of asthma (maintenance) Not a rescue Inhaler
Are corticosteroids administered before or after Bronchodilators?
After
An example of a Short-acting beta agonist (SABA) "rescue inhaler"?
Albuterol
The autonomic nervous system can be subdivided into which types of adrenergic receptors?
Alpha and beta
An example of an Antagonist is?
Anti-histamines; beta blockers
The nurse answers a client's call light and the client requests pain medication. What should the nurse do first?
Assess the patient's pain and pain level.
Common Lower Respiratory (LR) Disorders?
Asthma, COPD, Infections (Pneumonia)
Clinical Manifestations of asthma?
Bronchoconstriction,Inflammation, Mucous production
Albuterol is a Bronchodilator or Anti-inflammatory?
Bronchodilator
Fluticasone is a Bronchodilator or Anti-inflammatory?
Bronchodilator
Ipratropium is a Bronchodilator or Anti-inflammatory?
Bronchodilator
Montelukast is a Bronchodilator or Anti-inflammatory?
Bronchodilator
Salmeterol is a Bronchodilator or Anti-inflammatory?
Bronchodilator
Theophylline/aminophylline is a Bronchodilator or Anti-inflammatory?
Bronchodilator
Older Adult: Pharmacokinetic Alterations: Absorption:
Changes can result in decreased absorption of oral drugs
A client is prescribed ibuprofen 200 mg orally every 4 hours as needed for pain. The nurse is preparing to administer the medication, which is in the enteric-coated tablet form. The client refuses the tablets due to difficulty swallowing. What action should the nurse take?
Call the pharmacy and ask for the liquid form of the medication.
Clinical Manifestations of COPD?
Chronic cough, mucous production, Expiratory airway collapse w/air trapping
Teratogenic drugs
Cross placental barrier: Potential/actual harm to developing fetus
Inhaled corticosteroid Prototype: fluticasone (Flovent) action is?
Decrease inflammatory response in airways
Older Adult: Pharmacokinetic Alterations: Renal
Decreased blood flow, GFR, and overall function
Older Adult: Pharmacokinetic Alterations: Cardiovascular
Decreased cardiac output
Older Adult: Pharmacokinetic Alterations: Hepatic
Decreased enzyme production and decreased blood flow to the liver
Older Adult: Pharmacokinetic Alterations: Excretion
Decreased number of nephrons and GFR; increased risk toxicity
The nurse is preparing to administer multiple medications to a client and is concerned about several drug-drug interactions that may impact absorption. The medications are prescribed for what route?
Oral
What is a primary reaction (pharmacologic) ?
Overdose; extension of desired effect *ex- hypersensitive; hypotension)
The nurse is assessing a client with nausea and vomiting. Which additional autonomic symptoms may the nurse observe that often accompany vomiting?
Pallor, sweating, and tachycardia
Leukotriene Receptor Antagonist Prototype: Montelukast (Singulair) is indicated for?
Prophylaxis for asthma in adults & children
Common anticholinergic effects:
Relax bronchi, drowsiness, confusion, tachycardia, hypertension, dry mouth, pupil dilation, flushing, urinary retention, constipation
The nurse is preparing to administer a transdermal patch to a client. Upon assessment, the nurse finds the client currently has a medication patch on the right upper chest. What should the nurse do?
Remove the old patch and apply the new patch to a different, clean area.