NUR-641E Advanced Pathophysiology and Pharmacology for the Nurse Educator ALL SOLUTION 2025 EDITION GUARANTEED GRADE A+

NUR-641E Advanced Pathophysiology and Pharmacology for the Nurse Educator ALL SOLUTION 2025 EDITION GUARANTEED GRADE A+ Pharmacokinetics Involves ADME (absorption, distribution, metabolism and elimination). Absorption: absorption from the administration site either directly or indirectly into the blood/plasma. Distribution: reversibly or irreversibly move from the bloodstream into the interstitial and intracellular fluid. Metabolism: bio-transformed via hepatic metabolism or by other tissues. Elimination: lastly, the drug & its metabolites are eliminated from the body The route of administration with the highest bio-availability is Intravenous; putting entire dose into a patient's vein and bypassing absorption. Intravenous route avoids first-pass metabolism in the liver. rectal administration disadvantages variable and erratic absorption Steady state (SS) is usually reached within 4-5 half-lives of a drug The half-life of a drug is defined as how long it takes for half the drug to be excreted from the body Half-life of a drug Determines how frequently the drug must be administered Predicts how long toxic effects can last Half-life is constant with first-order pharmacokinetics of a drug Zero-order (nonlinear) pharmacokinetics means a drug is metabolized at a constant rate per unit time. CYP3A4 substrate drugs May have enhanced activity if any CYP3A4 inducer drugs are used along with it. Drug development steps (according to the FDA) Discovery: laboratory research to develop the new drug Pre-clinical research with animal testing for safety (Phase I) Clinical research on human subjects for medication safety (Phase II) Clinical research in humans comparing the new drug to accepted medications or placebo depending on the study (Phase III) FDA review of the results to determine approval Post-marketing study to identify adverse effects not found in earlier clinical studies (Phase IV) Medication safety organizations The Institute for Safe Medication Practices (ISMP) The Institute of Medicine (IOM) The Joint Commission The National Coordinating Council for Medication Error Reporting and Prevention (NCCMERP) Food and Drug Administration (FDA) Safe Use Initiative Adverse Drug Reactions (ADRs) Two basic type of ADRs: pharmacological and idiosyncratic. 85% to 90% of ADRs are pharmacological. Adverse drug reactions are usually preventable, frequently occur in a hospital or nursing home setting, and include medication errors, adverse drug effects, allergic and idiosyncratic type reactions. ADRs are not commonly reported; the FDA does not mandate that ADRs be reported. Polypharmacy involves using multiple healthcare providers for care, using multiple medications, and using several pharmacies for prescription filling. Cardiovascular-Angiotensin converting enzyme inhibitors (ACEIs): Lisinopril, captopril, enalapril, ramipril, benazepril, fosinopril; *ACEIs reduce blood pressure by suppressing the release of angiotensin-converting enzyme. *Important side effects of ACE inhibitors include cough and angioedema; discontinue the ACEI if angioedema occurs. Angiotensin II receptor blocking agents (ARBs): Candesartan (Atacand), eprosartan (Teveten), irbesartan (Avapro), losartan (Cozaar), telmisartan (Micardis) and valsartan (Diovan). ARBs reduce blood pressure by blocking angiotensin II receptors. Cardiovascular-Essential (primary) hypertension Accounts for 90% of cases; secondary hypertension may be caused by chronic renal failure. Nitroglycerin nitrate drug used in the treatment of angina; a nitrate drug that can be administered IV, SL, a topical ointment and as a transdermal patch PDE-5 inhibitors -Pulmonary hypertension therapy -Include sildenafil. Inhibit cGMP PDE5 and prolong vasodilatory effect of nitric oxide. cGMP phosphodiesterase an enzyme in cells that converts cGMP into GMP Amiodarone is the antiarrhythmic of choice when there is coexisting heart failure; can cause thyroid and pulmonary toxicity. Alpha-1 adrenergic stimulation results in vasoconstriction and increased blood pressure. Alpha-1 adrenergic blockade results in vasodilation and reduced blood pressure Beta-1 adrenergic stimulation by beta agonists (e.g., isoproterenol) results in increased heart rate, increased blood pressure and increased cardiac output. Beta-1 adrenergic blockade results in reduced heart rate, reduced blood pressure and reduced cardiac output. Left heart failure The heart does not adequately circulate blood to systemic system. Due to pressure overload or volume overload Right heart failure The heart does not adequately circulate blood to the pulmonic system. Can be due to volume overload or regurgitation in Tricuspid Valve or Pulmonic Valve. Can lead to systemic edema, back up of blood in liver and lower extremities Furosemide (Lasix) Loop diuretic; A drug that relieves heart failure symptoms but does not reduce mortality. Loop diuretics are potent diuretics, can cause diuretic resistance and hypokalemia, and work on receptors in the thick ascending renal loop of Henle. They also inhibit the re-absorption of sodium and chloride at this site in the kidney. Potassium-sparing diuretics spironolactone, triamterene, amiloride Milrinone phosphodiesterase inhibitor, used for acute heart failure. Tetralogy of Fallot congenital malformation involving four (tetra-) distinct heart defects Tetralogy of Fallot treatment Children that are diagnosed can stop hypoxic spells by squatting down (a compensatory mechanism) Patent ductus arteriosus (PDA) an abnormal opening between the pulmonary artery and the aorta caused by failure of the fetal ductus arteriosus to close after birth; a congenital heart defect with a continuous machine-like murmur heard over the left upper sternal border in both systole and diastole, a bounding pulse and a thrill on palpation. Patent ductus arteriosus (PDA) can be effectively treated with IV NSAIDs such as indomethacin. Raynaud's Disease a vasospastic disorder typically seen during cold weather; involves the small arteries and arterioles in the fingers; occasionally, the toes are also involved; is treated with dihydropyridine-type calcium channel blockers (e.g., nifedipine) because they cause peripheral vasodilation. Respiratory system: Asthma is an obstructive airway disease associated with airflow obstruction, mucus production, hyperactivity of the bronchial tissue, and inflammation. Asthma *Mild persistent asthma is best treated with a short-acting beta-2 agonist (SABA) plus an inhaled corticosteroid. *Moderate persistent asthma is best treated with an inhaled low-dose corticosteroid and a long-acting bronchodilator. *Severe persistent asthma is best treated with a long-acting beta-2 agonist (LABA) plus a high-potency inhaled corticosteroid plus an oral corticosteroid drug. Asthma treatment *Inhaled short-acting beta-2 agonists (SABA) are indicated only for PRN use. *Long-acting beta-2 agonists (LABA, e.g., salmeterol) should never be used in an acute asthma exacerbation; use a short-acting beta-2 agonist (SABA, e.g., albuterol). *Short-acting beta-2 agonists (SABA) are used in acute asthmatic attacks, but can increase heart rate, tremors, nervousness, and reduce serum potassium levels. Asthma: Corticosteroid teaching Instruct a patient on any inhaled corticosteroid product to rinse the mouth after each use of the inhaled corticosteroid product. Asthma: different types of inhalers used for treatments *Advair (fluticasone and salmeterol) is an example of a long-acting beta agonist and a corticosteroid. *Anoro Ellipta (umeclidium/vilanterol) is an example of a long-acting beta agonist and an anticholinergic agent. *Combivent (albuterol/ipratropium) is an example of a short-acting beta agonist and an anticholinergic agent. *Tiotropium is long-acting anticholinergic agent, not for acute asthmatic attacks, and is used once a day in asthma and COPD. Cystic fibrosis (CF) hereditary disorder of the exocrine glands characterized by excess mucus production in the respiratory tract, pancreatic deficiency, and other symptoms Cystic fibrosis (CF) a pulmonary disorder typically seen in childhood, with an increased production of a protein-producing thick mucus that blocks the airways, pancreatic ducts, sweat gland ducts and vas deferens. Cystic fibrosis (CF) CF of the pancreas is also known as fibrocystic disease of the pancreas. respiratory distress syndrome (RDS) a severe respiratory disease that is characterized by rapid respiratory failure; a lung disorder characterized by increased pulmonary resistance and caused by Cystic fibrosis (CF) which is a surfactant deficiency. Musculoskeletal: NSAIDS NSAIDS have anti-inflammatory, analgesic and anti-pyretic activity. The NSAID which is considered safe to use by individuals with heart disease is naproxen. Acetaminophen analgesic and anti-pyretic activity, but not anti-inflammatory activity Gout hereditary metabolic disease that is a form of acute arthritis, characterized by excessive uric acid in the blood and around the joints; treated with antigout drugs (e.g., allopurinol, colchicine, febuxostat) and uricosuric drugs (probenecid, sulfinpyrazone). The only drugs that directly work on the pathophysiological causes of gout are allopurinol and febuxostat. `Gout Renal calculi can occur as a comorbid condition in patients with gout. Colchicine reduces the inflammatory response seen in gout, reduces the pain in an acute gout attack, but does not stop gout from developing into chronic gouty arthritis. Colchicine efficacy is affected by its incidence of adverse effects. Xanthine oxidase Xanthine oxidase is a form of xanthine oxidoreductase, a type of enzyme that generates reactive oxygen species. These enzymes catalyze the oxidation of hypoxanthine to xanthine and can further catalyze the oxidation of xanthine to uric acid. Allopurinol treats chronic gout by decreasing uric acid production by inhibiting this substance. Urate lowering therapy (ULT) can initiate an acute gouty attack; concomitant colchicine, NSAIDS or corticosteroids are used with ULT drugs to decrease the incidence of ULT-induced acute gouty attacks. Allopurinol the agent of choice for individuals with gout and high serum urate levels with underlying renal dysfunction, history of tophaceous gout, or urinary calculi. Acute gouty attacks are treated preferentially with NSAIDS e.g., indomethacin, ibuprofen, naproxen, sulindac). NSAIDs can cause GI bleeding (indicated by darkening of stools and epigastric pain); one recommendation is switch to a COX-2 inhibitor (i.e., celecoxib). ankylosing spondylitis a form of rheumatoid arthritis that primarily causes inflammation of the joints between the vertebrae; a chronic inflammatory joint disease characterized by fusion and stiffening of the spine and sacroiliac joints. Acetaminophen overdose May cause acute liver disorders (e.g., acute hepatitis, hepatotoxicity); liver failure Osteoblasts bone forming cells Osteoclasts are cells that break down bone matrix; reabsorb bone tissue Osteomalacia/rickets a condition of insufficient bone mineralization (softening of bone r/t vit D deficiency) Osteoporosis a condition in which the bones become fragile and break easily; a metabolic disorder with reduced bone mass/density. Osteosarcoma bone cancer Paget's disease a disorder in which abnormal new bone growth occurs at a faster rate than normal, involving increased resorption of spongy bone tissue A pathologic fracture a fracture occurring at the site of a pre-existing bone abnormality, and occurs with a force that is considerably less than that which would cause a bone fracture at a different site. Electrolyte balance: Antidiuretic hormone (ADH) synthesized in the hypothalamus and causes the re-absorption of water in the distal tubule and collecting duct of the kidney. Hyponatremia treatment Fluid restriction If fluid restriction is not effective, give normal saline IV (0.9%NaCl). very slowly Orthostasis maintenance of an upright standing posture, can be a significant side effect with use of a diuretic drug. Orthostatic hyotension a decrease of 20mmHg systolic blood pressure or a decrease of 10mmHgdiastolic blood pressure within 3 minutes of assuming a standing position. Hyperkalemia causes low potassium intake, renal insufficiency, systemic lupus erythematosus, Addison's Disease, use of potassium-sparing diuretics. Treatment of hyperkalemia include calcium gluconate, loop diuretics, patiromer (Veltassa), thiazide diuretics, sodium polystyrene sulfonate (Kayexalate), regular insulin IV and inhaled albuterol. Insulin and beta-2 agonist inhalers are used to treat hyperkalemia because they move potassium from the bloodstream into the cells; insulin also increases the transport of glucose from the bloodstream into the cells. Calcium and phosphate homeostasis depends on calcitriol, calcitonin, and PTH hormone regulation; is affected by parathyroid hormone, vitamin D and calcitonin. Hypercalcemia causes bone hyperplasia, neoplasms, thiazide diuretics. Hypercalcemia treatment calcitonin, pamidronate, zoledronic acid Insufficient dietary intake of vitamin D can result in cardiovascular disease, osteoporosis and rickets. rickets osteomalacia in children; causes bone deformity insufficient dietary intake of vitamin B12 can result in pernicious anemia. pernicious anemia lack of mature erythrocytes caused by inability to absorb vitamin B12 into the bloodstream A patient with metabolic alkalosis and partial respiratory compensation CONTINUED..