lOMoARcPSD|44532475
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Exam 1 Review Guide
NUR2474 Pharmacology
Quiz 1
1. Nursing process as it relates to med administration
a. 6 Rights of Med Admin
i. Patient
ii. Drug
iii. Dose
iv. Time
v. Route
vi. Documentation
b. Extra rights to med admin
i. Assessment
ii. Evaluation
iii. Patient to education
iv. Patient to refuse care
c. Biggest medication error is misinterpreting prescriptions
i. Do not assume if something is unclear about an order. Clarify with prescriber.
ii. TORB and VORB
d. Pre- and post- medication administration assessment and interventions
i. Pre
1. If patient is complaining of pain 10/10, intervene (prn meds, standing orders,
call physician for new orders) then assess.
2. Collection of baseline data to evaluate therapeutic effects and adverse effects
3. Identification of high-risk patients
4. Assessment of the patient’s capacity for self-care
5. Allergies?
a) Collect history. What happens during an allergic reaction?
b) If patient is having an allergic reaction: primary intervention is to
STOP THE MEDICATION THAT IS CAUSING THE REACTION.
6. If patient refuses drug, determine why. INVESTIGATE.
ii. Post
1. Therapeutic response
2. Adverse reaction and interaction
3. Adherence to treatment
4. Satisfaction with treatment
2. Patient teaching for medication therapy in general (safety, compliance, etc.)
a. Teaching
i. Safety
1. If medication causing certain side effects, consult physician.
ii. Compliance
1. It is important not to stop or change a medication without consulting the
physician.
2. Take medications as prescribed and for the reason they are prescribed.
3. Side effects vs adverse effects vs allergies
a. Side effects
i. Nausea, vomiting, expected and unavoidable reactions, drug effects produced at
therapeutic level.
b. Adverse effects
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i. Noxious, unintended, and undesired effect that occurs at normal drug doses, harmful at
therapeutic level.
c. Allergies
i. Redness, itching, hives, swelling; A condition in which the immune system reacts
abnormally to a foreign substance.
4. Intended effect, teratogenic effect, paradoxical effect, tolerance
a. Intended effect
i. Maintenance of vital signs within expected limits
ii. Decrease in the risk of seizures
iii. Decrease in the intensity of withdrawal manifestations
iv. Substitution therapy during alcohol withdrawal
b. Teratogenic effect
i. Drug-induced birth defect
ii. Birth defects are not limited to distortions of gross anatomy; they also include
neurobehavioral and metabolic anomalies
c. Paradoxical effect
i. Opposite the intended drug effect
ii. Common example
1. Insomnia and excitement that may occur when some children and older adults
are given benzodiazepines for sedation.
d. Tolerance
i. Pharmacodynamic tolerance
1. Reduced responsiveness to a medication that clients take over time.
ii. Metabolic tolerance
1. Metabolism of medication increases over time and the effectiveness of the
medication declines.
iii. Cross-tolerance
1. Become tolerant to a medication that is chemically similar to another medication
they became tolerant of.
5. Half-life of medications
a. Defined as the time required for the amount of drug in the body to decrease by 50%
b. Percentage versus amount
c. Determines the dosing interval
d. Modafinil (CNS suppressant; narcolepsy)
i. about 15 hours
e. Phenytoin (Seizures)
i. 8-60 hours
1. lower doses: 8 hours
2. higher doses: 60 hours
f. Fluvoxamine (SSRI)
i. About 15 hours
g. Citalopram (SSRI)
i. About 35 hours
h. Duloxetine (SNRI)
i. 12 hours
Quiz 2
6. Donepezil (Aricept) therapy in patients with Alzheimer’s disease
a. Alzheimer’s Disease
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i. uncurable, cannot be delayed/slowed, or reversed. However cognitive decline can be
slowed down with meds. Cholinesterase inhibitors may cause fainting due to hypotension
and bradycardia.
b. Donepezil
i. Indicated for mild, moderate or severe AD
ii. Affects ACh levels
iii. Take acetaminophen (Tylenol) instead of NSAIDs (aspirin or ibuprofen)
iv. Inhibition/prevention to breakdown Acetylcholine (ACh)
v. Common side effects
1. Nausea/vomiting
2. GI discomfort (diarrhea)
3. dyspepsia (indigestion)
4. headache
5. fainting
6. falls/fall-related fractures
vi. Cholinesterase Inhibitors
vii. Inhibitors prevent acetylcholinesterase from inactivating ACh (prevents from doing their
job.)
viii. This causes an increase of ACh, therefore there is a decrease in dopamine.
ix. Too much ACh and too little dopamine is Parkinson’s
x. Too little ACh and too much dopamine is Alzheimer’s
7. Cholinesterase inhibitors and indications, side effects, cardiac effects
a. Cholinesterase inhibitors (donepezil, galantamine, rivastigmine)
i. Treatment of AD with these drugs can yield improvement that is statistically significant
but clinically marginal. (ex: taking a “weight loss drug” and losing half a pound in 6
months).
ii. Goal for AD treatment s to improve symptoms and reverse cognitive decline.
iii. Inhibitors prevent acetylcholinesterase from inactivating ACh (prevents from doing their
job). Prevent breakdown of ACh.
iv. This causes an increase of ACh, therefore there is a decrease in dopamine.
b. Indications
i. Mild to moderate AD
c. Side effects
i. Cholinergic side effects
1. Increased sweating
2. Loss of bladder control
3. Muscle weakness, cramps
4. GI upset (diarrhea, N/V, stomach cramps or pain)
5. Bronchoconstriction
a) SOB, tightness in chest, wheezing
6. Watering of mouth
ii. Fatigue
iii. Insomnia
iv. Dizziness
v. Headache
d. Cardiac effects
i. Slow or irregular heartbeat
ii. Dysrhythmia
iii. Hypotension
8. Interferon beta therapy (indications, side effects, etc.)
a. Interferon beta
i. Multiple Sclerosis
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1
Exam 1 Review Guide
NUR2474 Pharmacology
Quiz 1
1. Nursing process as it relates to med administration
a. 6 Rights of Med Admin
i. Patient
ii. Drug
iii. Dose
iv. Time
v. Route
vi. Documentation
b. Extra rights to med admin
i. Assessment
ii. Evaluation
iii. Patient to education
iv. Patient to refuse care
c. Biggest medication error is misinterpreting prescriptions
i. Do not assume if something is unclear about an order. Clarify with prescriber.
ii. TORB and VORB
d. Pre- and post- medication administration assessment and interventions
i. Pre
1. If patient is complaining of pain 10/10, intervene (prn meds, standing orders,
call physician for new orders) then assess.
2. Collection of baseline data to evaluate therapeutic effects and adverse effects
3. Identification of high-risk patients
4. Assessment of the patient’s capacity for self-care
5. Allergies?
a) Collect history. What happens during an allergic reaction?
b) If patient is having an allergic reaction: primary intervention is to
STOP THE MEDICATION THAT IS CAUSING THE REACTION.
6. If patient refuses drug, determine why. INVESTIGATE.
ii. Post
1. Therapeutic response
2. Adverse reaction and interaction
3. Adherence to treatment
4. Satisfaction with treatment
2. Patient teaching for medication therapy in general (safety, compliance, etc.)
a. Teaching
i. Safety
1. If medication causing certain side effects, consult physician.
ii. Compliance
1. It is important not to stop or change a medication without consulting the
physician.
2. Take medications as prescribed and for the reason they are prescribed.
3. Side effects vs adverse effects vs allergies
a. Side effects
i. Nausea, vomiting, expected and unavoidable reactions, drug effects produced at
therapeutic level.
b. Adverse effects
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2
i. Noxious, unintended, and undesired effect that occurs at normal drug doses, harmful at
therapeutic level.
c. Allergies
i. Redness, itching, hives, swelling; A condition in which the immune system reacts
abnormally to a foreign substance.
4. Intended effect, teratogenic effect, paradoxical effect, tolerance
a. Intended effect
i. Maintenance of vital signs within expected limits
ii. Decrease in the risk of seizures
iii. Decrease in the intensity of withdrawal manifestations
iv. Substitution therapy during alcohol withdrawal
b. Teratogenic effect
i. Drug-induced birth defect
ii. Birth defects are not limited to distortions of gross anatomy; they also include
neurobehavioral and metabolic anomalies
c. Paradoxical effect
i. Opposite the intended drug effect
ii. Common example
1. Insomnia and excitement that may occur when some children and older adults
are given benzodiazepines for sedation.
d. Tolerance
i. Pharmacodynamic tolerance
1. Reduced responsiveness to a medication that clients take over time.
ii. Metabolic tolerance
1. Metabolism of medication increases over time and the effectiveness of the
medication declines.
iii. Cross-tolerance
1. Become tolerant to a medication that is chemically similar to another medication
they became tolerant of.
5. Half-life of medications
a. Defined as the time required for the amount of drug in the body to decrease by 50%
b. Percentage versus amount
c. Determines the dosing interval
d. Modafinil (CNS suppressant; narcolepsy)
i. about 15 hours
e. Phenytoin (Seizures)
i. 8-60 hours
1. lower doses: 8 hours
2. higher doses: 60 hours
f. Fluvoxamine (SSRI)
i. About 15 hours
g. Citalopram (SSRI)
i. About 35 hours
h. Duloxetine (SNRI)
i. 12 hours
Quiz 2
6. Donepezil (Aricept) therapy in patients with Alzheimer’s disease
a. Alzheimer’s Disease
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3
i. uncurable, cannot be delayed/slowed, or reversed. However cognitive decline can be
slowed down with meds. Cholinesterase inhibitors may cause fainting due to hypotension
and bradycardia.
b. Donepezil
i. Indicated for mild, moderate or severe AD
ii. Affects ACh levels
iii. Take acetaminophen (Tylenol) instead of NSAIDs (aspirin or ibuprofen)
iv. Inhibition/prevention to breakdown Acetylcholine (ACh)
v. Common side effects
1. Nausea/vomiting
2. GI discomfort (diarrhea)
3. dyspepsia (indigestion)
4. headache
5. fainting
6. falls/fall-related fractures
vi. Cholinesterase Inhibitors
vii. Inhibitors prevent acetylcholinesterase from inactivating ACh (prevents from doing their
job.)
viii. This causes an increase of ACh, therefore there is a decrease in dopamine.
ix. Too much ACh and too little dopamine is Parkinson’s
x. Too little ACh and too much dopamine is Alzheimer’s
7. Cholinesterase inhibitors and indications, side effects, cardiac effects
a. Cholinesterase inhibitors (donepezil, galantamine, rivastigmine)
i. Treatment of AD with these drugs can yield improvement that is statistically significant
but clinically marginal. (ex: taking a “weight loss drug” and losing half a pound in 6
months).
ii. Goal for AD treatment s to improve symptoms and reverse cognitive decline.
iii. Inhibitors prevent acetylcholinesterase from inactivating ACh (prevents from doing their
job). Prevent breakdown of ACh.
iv. This causes an increase of ACh, therefore there is a decrease in dopamine.
b. Indications
i. Mild to moderate AD
c. Side effects
i. Cholinergic side effects
1. Increased sweating
2. Loss of bladder control
3. Muscle weakness, cramps
4. GI upset (diarrhea, N/V, stomach cramps or pain)
5. Bronchoconstriction
a) SOB, tightness in chest, wheezing
6. Watering of mouth
ii. Fatigue
iii. Insomnia
iv. Dizziness
v. Headache
d. Cardiac effects
i. Slow or irregular heartbeat
ii. Dysrhythmia
iii. Hypotension
8. Interferon beta therapy (indications, side effects, etc.)
a. Interferon beta
i. Multiple Sclerosis
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