NURS350: PHARMACOLOGY FINAL EXAM STUDY GUIDE
CONCEPTS:
Rights of Medication Administration
Medication Errors
Drug Classification
Drug Tolerance
- Body develops a physiological tolerance to the drug over time and higher doses of the drug are needed
to produce a therapeutic effect
Resistance and Dependence
- Resistance: commonly occurs with abx, usually due to overuse or misuse
- Dependence: body develops a physiological need for the drug to avoid withdrawal
Nursing Process
- Assessment
- Diagnosis
- Planning
- Implementation
- Evaluation
Adrenergic and Cholinergic Drugs
- Adrenergic drugs → sympathetic NS receptors
- Sympathetic NS: increase HR, increase BP, tachycardia, decreased urine production, dry eyes
- Cholinergic drugs → parasympathetic NS receptors
- Parasympathetic NS: decrease HR, decrease BP, bradycardia, increased urine production
Eye Drops
- Cycloplegic eye drops → produce mydriasis (pupil dilation) for eye exams and to allow for greater
outflow of AH to lower IOP
- Cholinergic eye drops → produce miosis (pupil constriction) to stretch the trabecular meshwork to allow
for greater outflow of AH to lower IOP
- Adverse effects: headache, induced myopia, and decreased vision in low light
- Example: pilocarpine (Isopto-Carpine)
- Mydriatic eye drops → cause pupil dilation
- Miotic eye drops → cause pupil constriction
- Beta-blocker eye drops → decrease production AH to lower IOP
- Contraindicated for patients with asthma or HF
- Example: timolol (Betimol)
Use of Probiotics
- Used to maintain normal flora in the body during abx use to avoid secondary infections (ex. yeast
infection, candidiasis)
Antacids → provide temporary relief from heartburn or indigestion
- Aluminum compounds → constipation
- Calcium compounds → constipation
- Magnesium compounds → diarrhea
Vitamin B12
- Vitamin supplement for pernicious anemia or absence of intrinsic factor
Use of Neuromuscular Agents
Risk for Hormone Replacement Therapy and Contraceptives
IV Fluid Therapy for: restoration of fluids and electrolytes, shock, sepsis, maintain BP
,Electrolyte Imbalances
- Hyponatremia → low sodium (Na+) → excessive water
- Hypernatremia → high sodium (Na+) → dehydration
- Hypokalemia → low potassium (K+) → dysrhythmias, cardiac conduction dysfunction
- Hyperkalemia → high potassium (K+) → dysrhythmias, cardiac conduction dysfunction
Treatment for Thyroid Disorders
- Hyperthyroidism → elevated thyroid function, Grave’s disease
- Treatment: Propylthiouracil (PTU), methimazole (Tapazole), radioactive iodine
- Hypothyroidism → inadequate thyroid function, Hashimoto’s disease
- Treatment: levothyroxine (Synthroid)
- Thyroid Cancer
- Treatment: surgery, radioactive iodine, levothyroxine therapy
Treatment for Diabetes Mellitus
- Type 1 DM → caused by the autoimmune destruction of pancreatic beta cells, resulting in lack of insulin
secretion
- Typical signs and symptoms: hyperglycemia, polyurina, polyphagia, polydipsia, glucosuria,
weight loss, fatigue
- Treatment: insulin replacement therapy (rapid-acting or long-acting)
- Type 2 DM → caused by unresponsive target cells resulting in insulin resistance
- Treatment: usually managed with antidiabetic drugs, insulin may be needed for additional
management
- Antidiabetic drugs: biguanide (metformin), sulfonylureas (chlorpropamide, glimepiride)
Antidepressants
- Monoamine Oxidase Inhibitors (MAOIs)
- Drug for depression
- Limit the breakdown of norepinephrine, dopamine, and serotonin in the CNS to create higher
levels of these neurotransmitters to alleviate symptoms of depression
- Low safety margin, these drugs are reserved for patients who have not responded to SSRIs or
TCAs
- Avoid foods with tyramine (may cause HTN crisis)
- Example: phenelzine (Nardil)
- Adverse effects: orthostatic hypotension, headache, insomnia, diarrhea, serotonin syndrome,
hepatotoxicity
- Selective serotonin reuptake inhibitors (SSRIs)
- Drug of choice for depression and anxiety
- Examples: escitalopram (Lexapro), sertraline (Zoloft)
- Adverse effects: weight gain, sexual dysfunction, serotonin syndrome
- Tricyclic Antidepressants (TCAs)
- Treats depression and anxiety
- Examples: amitriptyline (Elavil), imipramine (Tofranil)
- Adverse effects: anticholinergic effects (dry mouth, blurred vision, urine retention, constipation,
HTN)
- Contraindications: patients with a history of myocardial infarction, heart block, or arrhythmia
- Interactions: use with alcohol or other CNS depressants
, MEDICATIONS:
Ibuprofen (Advil, Motrin)
- Pharmacologic Class: non-steroidal anti-inflammatory (NSAID)
- Therapeutic Class: nonopioid analgesic, antipyretic, NSAID
- Uses: mild to moderate pain, inflammation, fever
- Mechanism of Action: inhibit cyclooxygenase (COX), an enzyme responsible for the formation of
prostaglandins, to reduce inflammation and pain
- Inhibits pain mediators at the nociceptor level (non-selective)
- Adverse Effects: nausea, heartburn, epigastric pain, dizziness, GI ulcers, peripheral edema, aplastic
anemia, leukopenia, prolonged bleeding, anaphylaxis, nephrotoxicity, ototoxicity
- Contraindications: peptic ulcers, kidney disease, CVD, HTN, HF, MI
- Interactions: other anticoagulants
- Nursing Considerations:
- Give the drug on an empty stomach as tolerated. If GI upset occurs, give with food.
- Patients with asthma or allergies to aspirin are more likely to exhibit a hypersensitivity reaction
to ibuprofen.
- Monitor intake and output
- Monitor kidney and liver function studies
- Monitor for GI upset, black or tarry stools, hypotension, signs of GI bleeding
- Monitor for hearing loss or changes
- Pregnancy Category: C, changes to D after 30 weeks gestation
Aspirin (Acetylsalicylic Acid, ASA)
- Pharmacologic Class: salicylate, non-steroidal anti-inflammatory (NSAID)
- Therapeutic Class: nonopioid analgesic, NSAID
- Uses: prophylaxis of cardiovascular events (anticoagulant activity), mild to moderate pain,
inflammation, fever
- Mechanism of Action: inhibit cyclooxygenase (COX), an enzyme responsible for the formation of
prostaglandins, to reduce inflammation and pain
- Inhibits pain mediators at the nociceptor level (non-selective)
- Adverse Effects: gastric discomfort and bleeding, prolonged-bleeding time, nephrotoxicity, ototoxicity
- Contraindications:
- Interactions: other anticoagulants
- Nursing Considerations:
- Medication should be discontinued 7 days prior to surgery
- Excreted in the urine and may affect urine testing for glucose and other metabolites
- Monitor for GI upset, black or tarry stools, hypotension, signs of GI bleeding
- Monitor for hearing loss or changes
- Pregnancy Category: D
CONCEPTS:
Rights of Medication Administration
Medication Errors
Drug Classification
Drug Tolerance
- Body develops a physiological tolerance to the drug over time and higher doses of the drug are needed
to produce a therapeutic effect
Resistance and Dependence
- Resistance: commonly occurs with abx, usually due to overuse or misuse
- Dependence: body develops a physiological need for the drug to avoid withdrawal
Nursing Process
- Assessment
- Diagnosis
- Planning
- Implementation
- Evaluation
Adrenergic and Cholinergic Drugs
- Adrenergic drugs → sympathetic NS receptors
- Sympathetic NS: increase HR, increase BP, tachycardia, decreased urine production, dry eyes
- Cholinergic drugs → parasympathetic NS receptors
- Parasympathetic NS: decrease HR, decrease BP, bradycardia, increased urine production
Eye Drops
- Cycloplegic eye drops → produce mydriasis (pupil dilation) for eye exams and to allow for greater
outflow of AH to lower IOP
- Cholinergic eye drops → produce miosis (pupil constriction) to stretch the trabecular meshwork to allow
for greater outflow of AH to lower IOP
- Adverse effects: headache, induced myopia, and decreased vision in low light
- Example: pilocarpine (Isopto-Carpine)
- Mydriatic eye drops → cause pupil dilation
- Miotic eye drops → cause pupil constriction
- Beta-blocker eye drops → decrease production AH to lower IOP
- Contraindicated for patients with asthma or HF
- Example: timolol (Betimol)
Use of Probiotics
- Used to maintain normal flora in the body during abx use to avoid secondary infections (ex. yeast
infection, candidiasis)
Antacids → provide temporary relief from heartburn or indigestion
- Aluminum compounds → constipation
- Calcium compounds → constipation
- Magnesium compounds → diarrhea
Vitamin B12
- Vitamin supplement for pernicious anemia or absence of intrinsic factor
Use of Neuromuscular Agents
Risk for Hormone Replacement Therapy and Contraceptives
IV Fluid Therapy for: restoration of fluids and electrolytes, shock, sepsis, maintain BP
,Electrolyte Imbalances
- Hyponatremia → low sodium (Na+) → excessive water
- Hypernatremia → high sodium (Na+) → dehydration
- Hypokalemia → low potassium (K+) → dysrhythmias, cardiac conduction dysfunction
- Hyperkalemia → high potassium (K+) → dysrhythmias, cardiac conduction dysfunction
Treatment for Thyroid Disorders
- Hyperthyroidism → elevated thyroid function, Grave’s disease
- Treatment: Propylthiouracil (PTU), methimazole (Tapazole), radioactive iodine
- Hypothyroidism → inadequate thyroid function, Hashimoto’s disease
- Treatment: levothyroxine (Synthroid)
- Thyroid Cancer
- Treatment: surgery, radioactive iodine, levothyroxine therapy
Treatment for Diabetes Mellitus
- Type 1 DM → caused by the autoimmune destruction of pancreatic beta cells, resulting in lack of insulin
secretion
- Typical signs and symptoms: hyperglycemia, polyurina, polyphagia, polydipsia, glucosuria,
weight loss, fatigue
- Treatment: insulin replacement therapy (rapid-acting or long-acting)
- Type 2 DM → caused by unresponsive target cells resulting in insulin resistance
- Treatment: usually managed with antidiabetic drugs, insulin may be needed for additional
management
- Antidiabetic drugs: biguanide (metformin), sulfonylureas (chlorpropamide, glimepiride)
Antidepressants
- Monoamine Oxidase Inhibitors (MAOIs)
- Drug for depression
- Limit the breakdown of norepinephrine, dopamine, and serotonin in the CNS to create higher
levels of these neurotransmitters to alleviate symptoms of depression
- Low safety margin, these drugs are reserved for patients who have not responded to SSRIs or
TCAs
- Avoid foods with tyramine (may cause HTN crisis)
- Example: phenelzine (Nardil)
- Adverse effects: orthostatic hypotension, headache, insomnia, diarrhea, serotonin syndrome,
hepatotoxicity
- Selective serotonin reuptake inhibitors (SSRIs)
- Drug of choice for depression and anxiety
- Examples: escitalopram (Lexapro), sertraline (Zoloft)
- Adverse effects: weight gain, sexual dysfunction, serotonin syndrome
- Tricyclic Antidepressants (TCAs)
- Treats depression and anxiety
- Examples: amitriptyline (Elavil), imipramine (Tofranil)
- Adverse effects: anticholinergic effects (dry mouth, blurred vision, urine retention, constipation,
HTN)
- Contraindications: patients with a history of myocardial infarction, heart block, or arrhythmia
- Interactions: use with alcohol or other CNS depressants
, MEDICATIONS:
Ibuprofen (Advil, Motrin)
- Pharmacologic Class: non-steroidal anti-inflammatory (NSAID)
- Therapeutic Class: nonopioid analgesic, antipyretic, NSAID
- Uses: mild to moderate pain, inflammation, fever
- Mechanism of Action: inhibit cyclooxygenase (COX), an enzyme responsible for the formation of
prostaglandins, to reduce inflammation and pain
- Inhibits pain mediators at the nociceptor level (non-selective)
- Adverse Effects: nausea, heartburn, epigastric pain, dizziness, GI ulcers, peripheral edema, aplastic
anemia, leukopenia, prolonged bleeding, anaphylaxis, nephrotoxicity, ototoxicity
- Contraindications: peptic ulcers, kidney disease, CVD, HTN, HF, MI
- Interactions: other anticoagulants
- Nursing Considerations:
- Give the drug on an empty stomach as tolerated. If GI upset occurs, give with food.
- Patients with asthma or allergies to aspirin are more likely to exhibit a hypersensitivity reaction
to ibuprofen.
- Monitor intake and output
- Monitor kidney and liver function studies
- Monitor for GI upset, black or tarry stools, hypotension, signs of GI bleeding
- Monitor for hearing loss or changes
- Pregnancy Category: C, changes to D after 30 weeks gestation
Aspirin (Acetylsalicylic Acid, ASA)
- Pharmacologic Class: salicylate, non-steroidal anti-inflammatory (NSAID)
- Therapeutic Class: nonopioid analgesic, NSAID
- Uses: prophylaxis of cardiovascular events (anticoagulant activity), mild to moderate pain,
inflammation, fever
- Mechanism of Action: inhibit cyclooxygenase (COX), an enzyme responsible for the formation of
prostaglandins, to reduce inflammation and pain
- Inhibits pain mediators at the nociceptor level (non-selective)
- Adverse Effects: gastric discomfort and bleeding, prolonged-bleeding time, nephrotoxicity, ototoxicity
- Contraindications:
- Interactions: other anticoagulants
- Nursing Considerations:
- Medication should be discontinued 7 days prior to surgery
- Excreted in the urine and may affect urine testing for glucose and other metabolites
- Monitor for GI upset, black or tarry stools, hypotension, signs of GI bleeding
- Monitor for hearing loss or changes
- Pregnancy Category: D
