NURS 2407 Pharmacology Exam

NURS 2407 Pharmacology Exam Module 1 – Foundations of Pharmacology Key Terms 1. Drug: Any chemical that can affect living processes 2. Pharmacology: The study of drugs and their interactions with living system 3. Clinical Pharmacology: The study of drugs in humans 4. Therapeutics (AKA Pharmacotherapeutics): The use of drugs to diagnose, prevent, or treat disease or to prevent pregnancy Characteristics of Drugs • Effectiveness: If a drug is not effective, IT SHOULD NOT BE USED!!!! • Safety: No safe drugs; all drugs can cause harm. Does the good outweigh the bad? • Selectiveness: Elicits only the response for which it is given. Properties to Consider • Can the patient afford the medication? • Can the patient physically take the medication? • Consider the route of administration selected • Will this medication interact with other medications the patient is taking? The Nx Process • Assessment o Objective Data: What the nurse sees, smells, feels, hears. o Subjective Data: What the patient says. (Family Hx, HPI, Socioeconomic status, pain level) • Diagnosis (Nursing Dx) • Planning/Goal setting o Realistic, measurable, and timed. • Implementation • Evaluation o Were the goals met? ▪ Yes: Document findings. ▪ No: Document findings, adjust, and try again. 5 Rights of Medication Administration 1. Patient 2. Medication 3. Dose 4. Route 5. Time Enteric: of, relating to, or occurring in the GI tract. Enteric coated medications absorb in the small intestines. Parenteral: outside the GI tract. Fat-soluble (lipid-soluble) & Nonionized (no electrical charge) are most easily absorbed by the GI tract. “Topical” medications include: • Eye drops • Ear drops • Nasal sprays • Respiratory inhalants • Transdermal meds • Sublingual meds 3 Phases of Medication Administration • Pharmaceutic Phase: Process in which the tablet or capsule becomes a solution so it can cross the biologic membrane of the stomach or small intestines. o Only applies to tablets or capsules. • Pharmacokinetic Phase: This is the process of drug movement through the body to achieve drug action. o Absorption: movement of a drug from it’s site of administration into bloodstream. High fat foods increase absorption time. Exercise can decrease drug absorption because blood flow is in peripheral muscles instead of GI tract. o Distribution: The process by which the drug becomes available to body fluids and body tissues from the bloodstream. High affinity for proteins: warfarin and furosemide Low affinity for proteins: Lisinopril and metoprolol Blood Brain Barrier • Blocks about 98% of drugs on the market • Benzodiazepines are able to cross through diffusion = faster onset o Metabolism/ Biotransformation: The chemical alteration of drug structure. o The liver changes lipid-soluble substances to water-soluble substances for renal excretion. o The main site where this occurs is the Liver Prodrugs: inactive compound becomes active First pass effect: Drug is partially metabolized in the liver before reaching its intended effect. Bioavailability: The percentage of the administered dose that reaches systemic circulation. IV medication has a 100% bioavailability. o Excretion/Elimination: Accomplished mostly through the kidneys. Half-Life: The time it takes for the amount of drug to be reduced by half. Drugs with long half-life 24 hours should not be dosed more than once per day. • Pharmacodynamic Phase: What the drug does to the body. Onset of action: the time until minimum effective action/concentration. Peak action: when the drug reaches its highest plasma or blood concentration. Duration of action: the length of time the drug produces a therapeutic or pharmacologic effect. Agonists: produce a response. Antagonist: block a response. Peak: the point at which plasma drug levels are highest. Trough: the point at which plasma drug levels are lowest. Loading Dose: Given to achieve a rapid minimum effective concentration in the plasma. Drug-Drug Interactions Additive Effect (1+1=2): When two drugs with similar action are administered and the effect is the sum of the effects of the two drugs administered. Synergistic Effect (1+1=5): When two or more drugs are given together and the combined effect is substantially greater than the combined effect of the two. Antagonistic Effect: When two drugs are given that have opposite effects are administered together, with the two drugs canceling each other out. Drug Lab Interactions Drugs can interfere with clinical lab testing. Adverse Reactions: Unintended, unexpected, undesirable reactions, that occurs at normal doses. MUST BE REPORTED AND DOCUMENTED!! • Side Effects: Unavoidable secondary drug effect produced at therapeutic doses. • Toxicity: The degree of detrimental physiologic effects caused by excessive drug dosing. • Idiosyncratic Effect: Uncommon drug response resulting from a genetic predisposition. • Allergic Reaction: An immune response to a drug after prior sensitization has occurred. • Paradoxical Effect: The opposite of the intended drug response. • Iatrogenic Disease: Disease produced by drugs. • Physical Dependence: The state in which the body had adapted to drug exposure in such a way that an abstinence syndrome will result if drug use is discontinued. • Carcinogenic Effect: The ability of certain medications or environmental chemicals to cause cancer. • Teratogenic Effect: Drug-induced birth defect. Hepatotoxicity: Damage done to the liver after drugs undergo metabolism QT Interval Drugs: Drugs that can cause QT changes on an EKG, causing lethal dysrhythmias like torsades de pointes. Drug Induced Photosensitivity: Caused by the interaction of a drug and exposure to UVA light which can cause cellular damage. • Using sunscreen with SPF 15 and wearing protective clothing can help prevent this reaction. Food and Drug Administration (FDA): Designed to allow safe food and drugs to be distributed and sold in the U.S. 5 Drug Categories: Schedule I, II, III, IV, V • I: No accepted medical use in the U.S., or high potential for abuse (LSD, Heroin) • II-V: accepted medical applications but also have high potential for abuse (ADHD, pain, and anxiety medications) Placebo: A psychological benefit from a compound that may not have the chemical structure of a drug effect. Generic Names: Chemical name for a drug. Brand Names: Name the drug is marketed under. Module 2 – Neurological System Medications (1) Autonomic Nervous System • Sympathetic (adrenergic) o Neurotransmitter: Norepinephrine ▪ Alpha 1 ▪ Alpha 2 ▪ Beta 1 ▪ Beta 2 o Adrenergic Agnostic ▪ Also called: Adrenergic ▪ Also called: Sympathomimetics o Vasoconstriction = increased blood pressure. o Increased contractility of the heart and increased heart rate. o Bronchodilation. o Liver stimulation increases blood sugar. o Pupil dilation. o Alertness • Parasympathetic (cholinergic) o Neurotransmitter: Acetylcholine ▪ Nicotinic ▪ Neuromuscular ▪ Affect skeletal muscle ▪ Muscarinic ▪ Stimulate smooth muscle ▪ Slow heart rate o Cholinergic Agnostics ▪ Cholinergic ▪ Parasympathomimetic o Stimulates urination o Increases salivation and tear production o Increases GI peristalsis • Adrenergic Blockers o adrenergic antagonists o sympatholytic Blocks access to the adrenergic receptor sites. • Anticholinergics o Cholinergic Antagonists o Parasympatholytic Blocks the parasympathetic nerves, the adrenergic nervous system dominates. Parkinsonism Too little dopamine and too much acetylcholine. • Carbidopa/Levodopa (Sinemet) o Levodopa is converted to dopamine before it reaches the brain. o Slows the progression of parkinsonism. o Side effects ▪ GI upset ▪ Dyskinesia ▪ Orthostatic HTN Alzheimer’s Disease • Donepezil (Aricept) o Prevents the breakdown of acetylcholine. o Side effects ▪ Bronchoconstriction ▪ Bradycardia ▪ Dyspepsia • Memantine (Namenda) o Binds to NMDA receptor sites, preventing binding of glutamate, an excitatory neurotransmitter. o Side Effects ▪ Confusion ▪ Headache ▪ Constipation Multiple Sclerosis A chronic inflammatory autoimmune disorder that attacks the myelin sheath of neurons in the CNS. Plaques form on the brain. • Interferon Beta-1a (Avenox) o Decrease the frequency and severity of attacks reduces size of lesions, and delays progression. o Side Effects ▪ Hepatotoxicity ▪ Bone Marrow Suppression ▪ Depression ▪ Immune Suppression – Risk for Infection Seizure Disorders Medications Binds to inactive neuron sodium inactive preventing and influx. • Phenytoin (Dilantin) o Side Effects ▪ Nystagmus ▪ Slurred speech ▪ Thrombocytopenia ▪ Gingival hyperplasia • Patient Teaching: Good oral hygiene ▪ Blood pressure ▪ Teratogenic o Suppresses seizures w/o depressing the CNS. • Oxcarbazepine (Trileptal) o Side Effects ▪ Neurologic side effects ▪ Steven-Johnson Syndrome ▪ Nystagmus ▪ Multiorgan hypresensitivity reactions o Avoid driving & alcohol • Phenobarbital (Luminal) o inhibition of GABA o Side Effects ▪ Hypoventilation ▪ Hypotension ▪ Bone Marrow Suppression o Use activated charcoal. Drugs for Muscle Spasm and Muscle Disorder • Baclofen (Lioresal) o Suppresses hyperactive reflexes withing the spinal cord. o Adverse Side Effects o CNS depression o Urinary Retention • Cyclobenzaprine (Flexmid) o Reduces tonic motor activity o Ineffective for spasticity o Adverse Reactions o CNS depression o Anticholinergic effects CNS Stimulants and ADHD Increases the activity of CNS neurons • Methylphenidate (Ritalin) • Dexmethylphenidate (Focalin) o Also treats narcolepsy • Side Effects o Insomnia o HTN o Weight loss o Cardiac dysrhythmias Module 3 – Neurological System Medications (2) Dopamine: Cognition, hormones, emotions, movement. Norepinephrine: Arousal, attention, mood, concentration, anxiety. Acetylcholine: Smooth muscle, dilates pupils, body secretions. Serotonin: Regulates sleep, mood, nausea. Neuroleptic Malignant Syndrome • High Fever (105 F) • Muscle Rigidly. • Irregular Pulse • Tachycardia • Altered Mental Status • Tx: Dantrolene Serotonin Syndrome • Cognitive Changes o Agitation o Confusion o Euphoria o Hallucinations • Autonomic Changes o Tachycardia o HTN o Fever o Arrythmias • Neuromuscular Changes o Tremor o Hyperreflexia o Ataxia o Seizures Extrapyramidal Syndrome • Psuedoparkinsonism o Pill Rolling o Tremors o Shuffling Gait • Acute Dystonia o Sustained Muscle Contraction • Akathesia o Restless Legs • Tardive Dyskinesia (TD) o Involuntary wormlike movement of head, neck, face, trunk, and tongue. ▪ IRREVERABLE EPS Tx (Early) • Anticholinergics • Benzodiazepines • Beta Blockers • Reduce Dosage EPS Tx (Late) • Reduce Dose Prevention of HTN Crisis Avoid • Cheese • Meat • Chocolate • Bananas • Raisins • Fermented goods Schizophrenia First Generation Antipsychotics (Typical/Conventional) Treats positive & negative symptoms • Chlorpromazine (Thorazine) • Haloperidol (Haldol) • Blocks: o Dopamine (EPS – Parkinsonism) o Acetylcholine (Anticholinergic) o Histamine (Drowsiness) o Norepinephrine ( B/P & HR) • Contraindicated in Parkinson’s Disease. • Can lead to EPS & NMS. Second Generation Antipsychotics (Atypical) • Clozapine (Clozaril) • Olanzapine (Zyprexa) • Treats positive and negative symptoms. • Side Effects o EPS o NMS o Agranulocytosis o Metabolic Issues (Diabetes, Wt. gain, Dyslipidemia) Antidepressants MAOI Prevents breakdown of dopamine, norepinephrine, and serotonin (5-HT) • Phenelzine (Nardil) • Side Effects o HTN Crisis o Sexual Dysfunction o Cardiac Arrest o Serotonin Syndrome o Insomnia TCA Inhibits metabolism of serotonin & norepinephrine • Blocks acetylcholine • Amitriptyline (Elavil) • Imipramine (Tofranil) • Do Not Mix with MAOI • Administer sodium bicarbonate to control dysthymias SSRI Increases serotonin levels • Fluoxetine (Prozac) • Sertraline (Zoloft) • Side Effect o Sexual Dysfunction o Insomnia • Limit grapefruit juice SNRI • Venlafaxine (Effexor) • Duloxetine (Cymbalta) o Also treats pain • Risk of Serotonin Syndrome Atypical Antidepressants Increases Dopamine • Bupropion (Wellbutrin) • Increases appetite • Increases Sexual desire and pleasure • Smoking cessation Bipolar Disorder Bipolar 1: Mixed or Mania Bipolar 2: Hypomanic/Depression • Lithium o Used for Mania or Depression o Avoid Sodium-free diet & Dehydration o Reduces Euphoria o Teratogenic o Do not mix with ACE inhibitors & NSAIDS o Palpitations & Dysrhythmias = levels. • Divalproex Sodium/Valproate (Depakote) o Gather baseline CBC o Causes thrombocytopenia o Teratogenic • Carbamazepine (Tegretol) o metabolism of itself, warfarin, and oral b/c o Side Effects ▪ Amenia ▪ Thrombocytopenia ▪ Fever & Sore throat Anxiolytics Benzodiazepines Increases GABA in the CNS • Lorazepam (Ativan) • Diazepam (Valium) • Alprazolam (Xanax) • Reversal Agent: Flumazenil (Romanzicon) • Short term use • Helps treat alcohol withdrawal • Side Effects o Confusion o Amnesia o Anticonvulsant Azapirones • Buspirones o No sedation or dependency