Pharmacology Final Exam Study Guide 2024

Why do we do the 5 rights when giving medications? – answers 1. right drug 2. right person 3. right dose 4. right route 5. right time To ensure patient safety How many patient identifiers do we need? - answersWe need 2 patient identifiers to ensure that it is the correct patient How do you give sublingual nitroglycerin - answersHave patient put medication underneath their tongue while sitting or lying down 3 doses within 15 minutes with each dose being 3-5 minutes apart Kept away from light in a container Systolic must remain above 90 Benefit of giving a transdermal patch? - answersGives the medication a constant level, where the levels in the body do not fluctuate as much Trough levels - answersLowest plasma concentration of a drug and it measures the rate at which the drug is eliminated from the body Rate of elimination Drawn immediately before the next dose is given What drugs do you draw trough levels for? - answersDrugs that have a narrow therapeutic index Therapeutic index - answersEstimates the margin of safety for a drug using a ratio that measures the effective therapeutic dose in 50% of people and the lethal dose in 50% of people Closer the number to 1 the higher the likelihood of danger What drugs do you draw peak and trough levels for? - answersDigoxin Aminoglycosides What are peak levels - answersRate of absoprtion If someone has reoccurring infections and they keep taking antibiotics and they are no longer working what has happened? - answersThey have developed acquired bacterial resistance Onset of action - answersTime it takes for a drug to reach the minimum effective concentration after a drug is administered (MEC) How are drug doses perscribed - answersAccording to the % that the drug does not bind to protein Any amount of the drug that does not bind to protein has an effect, if it is bound to protein it cannot do anything Half-life of a drug - answersTime it takes for half of the drug concentration to be eliminated 650mg aspirin half-life: 3hrs it would take 3 hours for 325 to be left and 6 hours for 162mg to be left and so on Benefits of using a generic drug? - answersCost effective Who governs all drug administration by nurses? - answersNurse practice acts: every state has its own laws Native American view about time - answersThey are concentrated about today, not tomorrow Exhibit less dependence on a strict time schedule for economic and social activities Present measures to ease comfort not long term wellness, and more likely to discontinue meds after feeling better What drugs are metabolized differently in African Americans and therefore are not as effective? - answersAntihyperstensive agents Beta blocker, and ACE inhibitors Drug interaction - answersAltered or modified action or effect of a drug as a result of interaction with one or multiple drugs Antagonistic: Cancels out another drug Synergistic: More effective together If pt is taking a medication and starts taking an OTC drug as well and states that the prescription drug is no longer working, why is it no longer working? - answersBecause of a drug interaction Anti ulcer drug semedadine/tagment is a? - answersHepatic enzyme inhibitor Used for ulcers What type of interaction when taking semedadine and theophylline? - answersSemedadine will make theophylline stay in the body longer so therefore the pt will need the dosage of theophylline lowered until taken off of semedadine Characteristics of drug abuse - answersJittery, anorexia, tachycardia: speed Changes in personality, job performance, poor judgement, inappropriate behavior, errors, physical and emotional symptoms How do you know when a smoker is ready to quit? - answersWhen they state that they are truly ready to quit What should a person do before taking herbs? - answersTalk with their health care provider Feverfew should not be taken by whom? - answersWoman who are pregnant Babies have immature what? - answersHepatic and renal systems Meds stay in their bodies longer Laws for children - answers2002: Best pharmaceutical for children act--> gave drug manufactures an extension of their patent to evaluate drugs on the market for their safety and efficiency in children 2003: Pediatric research equity act-->authorizes the FDA to require that drug manufactures test drugs and biological products for their safety and effectiveness in children noting that children are NOT small adults When dealing with an adolescent patient what do you want them to be able to do? - answersVerbalize their feelings about a procedure Geriatric considerations when prescribing medications - answerswhole body works slower: same with children: Decreased liver and kidney/ hepatic and renal function Lower albumin so drug cannot bind to protein 2 tests for the kidneys - answersBUN & creatinine What do you want elderly patients to bring to their doctor visits - answersList ad or all of their medications People in a research study may do what at anytime? - answersStop or end their participation without penalty What is phase 1 of a drug study - answersPrimarily designed to assess safety and the objective is to determine the human dosage range based on the response in healthy human beings and to identify the pharmakokinetics of the drug First they try the drug on healthy people without the disease Second on people with the disease QSEN patient and family centered care - answersPt as source of control full parter in providing care that is compassionate and coordinated care based on respect for pt preferences values and needs Autonomy - answersPt as source of control Collaboration and teamwork QSEN - answersFunction effectively in nursing and interpersonal teams fostering open communication mutual respect and shared decision making to achieve quality pt care If person is allergic to penicillins can you give them amoxicillin? - answersNO The drug of choice is arithromyocin/azithromyacin What can happens when azithromyacin is taken with other hepatic drugs such as acetaminophen and tylenol and diphenahydramine (benadryl) - answersHepatotoxicity so you always need to check liver enzymes What pt teaching is there for a pt who is taking sulfa drugs: sulfamenadines Bactrim and septrim - answersIncrease fluid intake: several quarts/ forms crystals in urine/ kidney stones If a pt is taking bactrim and septrim and they get a vaginal infection why did they? - answersFrom a superinfection Sores in mouth, tongue, vaginal infections, (yeast infections) Who should take prophylactic anti tubercular therapy? - answersIndividuals who have been in close contact with someone who have been in close contact with persons with TB Why do we use 3 drugs to treat TB? - answersTo decrease the likeliness of becoming resistant to one of them What are the side effects of anthelmintics (worms) - answersAll GI side effects Should administer after meals to avoid GI effects Pt teaching for a person with worms or on anthelmintics - answersThey should take a shower/ not a bath Wash hands before eating and after going to the toilet If someone has had trouble sticking to a medication regimen in the past what should the nurse do to prevent it - answersGive them written and verbal information about each drugs purpose If you are working with people who have HIV and you get stuck with a needle what should you do? - answersGet 4 weeks of antiretral viral therapy Child on antibiotics for ear infection comes in after taking all of the antibiotics for a wellness appointment can they get vaccines? - answersYes Do not give until 1 week after antibiotics or if they currently have an infection A mother asks if it is really necessary for her 9 year old daughter to get gaurdasil what would you tell her? - answersYes its better to get vaccinated before sexual intercourse Why are 2 agents often given with chemo drugs - answersBecause they have a synergistic effect, they work better together What should a home health nurse wear when giving IV chemo? - answersImpermeable and disposable gown when hanging the drug Pt taking interferon alpha and they develop chills, fever, and malaise what should you do? - answersNotify the provider and anticipate an order for tylenol Prior to giving the drug the nurse could administer acetaminophen and diphnhydromine What is the blood test to make sure a pt is in heart failure and not COPD - answersBNP If a pt has a patch you know they understand the teaching if they say they are going to do what? - answersRotate sites What lifestyle changes can you make to avoid hypertension - answersWeight reduction and decrease sodium 80 year old taking thiazide for hypertension what should you do - answersTell them to sit up slowly Initiate fall risk protocall Taking care of post op pt what do you give to prevent DVT formation - answersLow molecular weight heparin If someone is taking heparin and they are bleeding a lot what do you get an order for? - answersProtamide sulfate Cholesterol level of 270 is what? - answersHigh risk for coronary artery disease If someone has been taking a statin lipitor for a long time and develops muscle weakness and tenderness what should you do? - answersCall the doctor because it is probably rhabdomyolysis Pt in ER HR 98 crackles in lungs 02 93 what do you do first? - answersAdminister oxygen After first nitro everything drops really low what should you do before giving another - answersNotify the doctor before giving another Pt has rash and runny nose after eating strawberries what do you do? - answersGet a set of vital signs before calling the doctor Someone taking a nasal decongestant too long and gets worst what should you tell them? - answersIf they stop taking it, then it will get better Migraine headaches - answers-Generally cause severe throbbing pain -Often preceded by an aura -Can be due to low serotonin, or certain foods -Beer -Red wine -Aged cheese -Chocolate -Caffeine Cluster headaches - answers-Unknown cause, but generally considered to be caused by the hypothalamus activating the trigeminal nerve -Recur 1-3 times daily in a period lasting 2 weeks to 3 months -Don't usually have triggers but once a cluster headache begins alcohol, nicotine, and nitro immediately lead to a severe headache What top two things should you avoid when you get cluster and migraine headaches? - answers-Chocolate -Caffeine What can access caffeine cause? - answers-Seizures -Arrhythmias What stage of sleep do dreams occur? - answers-During the REM stage of sleep is when the most recallable dreams occur Many OTC sleep aids are antihistamines (benadryl), if pt is taking a benzo for a prolonged time what should they be sure to do? - answersTapper off of the medication slowly and not to just discontinue it abruptly After a pt receives spinal anesthesia how long should they remain lying on their back for? - answers6-8 hours supine How long will pts with epilepsy take anticonvulsants for? - answersThis is a medication that those with epilepsy will remain taking for the rest of their life Child comes into the hospital with multiple seizures and is intibated what will you give them? - answersValume The condition is also referred to as status epilepticus Pregnant woman with seizures what would you give them? - answersGive her magnesium sulfate -1st line of action for a pregnant women who is having seizures and experiencing high blood pressure Person who has a shuffling gait, involuntary tremors of the limbs, and lack of facial expression has what? And what would you treat this condition with? - answers-Parkinsons -Carbadopa/levodopa What are the three cardinal symptoms of Parkinsonism? - answers-Rigidity -Tremors -Bradykinesia Alzheimers - answers-Chronic, progressive, neurodegenerative condition with marked cognitive dysfunction -The cause is really unknown Parkinsons - answersImbalance in dopamine and acetlycholine What is the highest priority for an advanced Alzheimer's pt? - answers-Assist the pt with care needs, ADL Myasthenia's gravis what symptoms would you worry about - answers-Worry about their respiratory system and facial muscles Pt given mestinon and having severe muscle weakness, excess salvation, pupil constriction, and fasciculation what would you do? - answersGive the pt atropine MS - answers-Weakness of extremities -Double vision What tests can detect MS - answers-Cerebral spinal fluid -Aminoglobulin G -MRI Cox 1 and Cox 2 - answers#2 converts acid into chemical mediator for inflammation -Asprin inhibits Cox1 and Cox2 What are the cardinal signs of inflammation? - answers-Redness(erythema) -Swelling(edema) -Heat -Pain -Loss of function If you have a pt come in with bad pain what is the first thing that you are going to have them do? - answersRate their pain on a scale of 0-10 Pt in PACU with several S/S, and has a morphine IV what is the #1 priority of this patient? - answersRespiratory depression/problems Who would you not want to give opioids to? - answersSomeone that has a closed head injury Who requires an increased amount of an opioid and it would be more so okay to do? - answersA cancer pt How do you administer IM haldol? - answersZ-track Pt comes in complaining that their prescription for atavan(lorazepam) that they have been on for 6 months is not working well enough and why? - answersThis pt has built up a tolerance to the medication Pt comes in that has been on a medication for anxiety and depression and it is not working what would you tell them? - answersThe medication can take up to 2 weeks to become affective Pt who is taking zoloft c/o not sleeping well what would you do? - answersAsk the pt what time they are taking their medication A pt who is taking efexir would want to stay away from what other type of medication/herbal remedy? - answersSt. Johns Wart Why are MAO inhibitors not prescribed anymore? - answersThis medication requires strict dieting, such as a lot of food restrictions Pt comes in with signs of lithium overdose what would you do? - answersGet an order to check their lithium drug level If a pt is on dramamine and they are boarding their plane at 9:00 what time would you tell them to be sure and take the dose? - answers8:30 With this medication you want to take it 30 minutes before What is the best advice for a woman that comes in and is 2 months pregnant and is having N/V? - answersTell the pt to eat saltine cracker, this route is safer for the baby If a pt keeps having unexplained reoccurring vomiting episodes what would you give? - answersYou would want to get an order to administer IV fluids and electrolytes How can you tell a pt to prevent travelers diarrhea? - answersYou would tell them to make sure and drink lots of bottled water and to only ingest meats that are very well cooked Pt comes in and says that the nexium that they were prescribed it working very well what would you tell them? - answersTo keep taking the medication for another 4 weeks If a pt has Zollinger Ellison what shouldnt they take? - answersSedmedadine (tagament) Pt is taking zantak for a peptic ulcer and c/o not feeling any better what would you do? - answersTell them to take at least 2 more weeks of the medication in order to feel better Eye drops are administered prior to an eye exam, when can the exam then begin? - answersWhen there is an absence of a blink reflex Timalol eye drops are given to a pt for glaucoma how would you prevent bradycardia from occurring? - answersYou would push on the lacrimal ducts An adolescent who is a life guard gets external otitis how would you tell them that they can prevent this from happening? - answersAfter being in the water they should dry their ears with a hair dryer Pt comes in with acne what would you tell them to do? - answersCleanse the skin GENTLY several times per day What should you test a pt for before giving them a prescription for Enbrel? - answersTest the pt for TB Pt is putting silvadine on their burns and is experiencing burning after doing this what is the reasoning? - answersBurning is an expected adverse reaction of the medication What is the name of the pepsin inhibitor that coats the gastric lining of the stomach? - answerssucralfate (Carafate) Growth hormone - answersActs only on newly forming bones before the epiphyses plates fuse. What route must growth hormone be given? - answersSubQ or IM Growth hormone therapy - answersCan either replace or inhibit GH Can really mess with insulin in your body, leading to diabetes. (Effects BS) Somatotropin - answersHelps children who have a growth deficiency Kids that are obese or have resp problems should not take Acromegaly - answersExcessive growth after puberty Caused by excessive secretion of GH or from a tumor What is acromegaly treated with? - answersOctreotide or Bromocriptine mesylate Octreotide - answersSuppresses GH release Can be used alone or with surgery and radiation S/E: GI effects Also used for excessive diarrhea from tumors Bromocriptine mesylate - answersSuppresses and decreases GH levels but also decreases lactation and prolactinoma Levothyroxine sodium - answersIncreases T3 and T4 Treats goiter and Hashimoto Liothyronine - answersRAPID ONSET!! Used frequently as initial therapy for Myxedema. Short half life/works fast Liotrix - answersCombination thyroid medication of levothyroxone and liothyronine SE: if you get too much thryoid medication? - answersN/V Tremors Headache Weight loss Tachycardia Hypertension Palpitations What are the types of diabetes? - answersType 1 Type 2 Secondary diabetes Gestational diabestes Type 1 - answersOccurs at a young age Can get it from a viral infection or environmental conditions Your body does NOT produce insulin Type 2 - answersMOST COMMON Caused from heredity and obesity Body makes some insulin Secondary Diabetes - answersOccurs temporarily in pre-diabetic patients taking certain medications Gestational diabetes - answersOccurs during the 2nd and 3rd trimesters of pregnancy. Hormone levels will increase during this time inhibiting the body's insulin usage Before calling a physician what do you want to be sure and do? - answersGet a complete set of VS Pnemothorax - answersWhen you puncture the lung S/S: sharp chest pain, decreased breath sounds Air embolism - answersS/S coughing, SOB, chest pain, cyanosis All types of diabetes are marked by what same 3 key symptoms? - answers1. Polyuria 2. Polydipsia 3. Polyphagia Pt comes into the ER unconscious what should you do? - answersGive them sugar in the form of Glucagon or Dextrose Easier to bring their sugar down then to have to keep trying to bring it up What is the only type of insulin that can be given through an IV? - answersRegular insulin What vitamin is important during pregnancy? - answersFolic acid Important for neural development Prevents spinabifida Water soluble vitamins - answersDo not get stored in the body Gest excreted readily Vitamins B and C Fat soluble vitamins - answersGet stores in fatty tissue, liver, and muscle Slowly metabolize Vitamins D,A,K,E Vitamin C - answersPrimarily found in veggie bruger. In citrus fruits and green veggies Vitamin D - answersTaken with calcium Helps to reduce fractures Required for calcium absorption Lactated Ringers Solution - answersPurpose is for hydration and electrolyte replacement. Do not give to a pt with liver disease Replenishes fluid volume Normal sodium level - answers135-145 Normal potassium level - answers3.5-5.0 Thiazide diuretic - answersCauses hypercalcemia, hyperglycemia Interacts with DIGOXIN Used for hypertension and edema Kayexalate - answersUsed for SEVERE hyperkalemia. May cause hypocalcemia, hypomagnesium Retains sodium Normal saline - answers0.9% An isotonic solution used for hydration Should not be used for long periods of time Enteral Nutrition - answersInvolves GI tract Can be given orally or via tube feeding What assessments would you do before enteral feeding? - answersCheck for distended abdomen, listen for bowel sounds Ask pt about last BM What is a potential complication with TPN? - answersAir embolism It can be prevented by closing clamps Aspiration pneumonitis - answersComplication of enteral feeding Occurs if pt is lying down while getting the feeding Pt must be sitting up Bethanechol chloride Urecholine - answersUsed to increase urination during UTI Can cause orthostatic hypotension For pts who have a neurogenic bladder DO NOT GIVE TO ASTHMATICS Direct acting cholinergic agonist that blocks SNS and contracts the bladder Atropine sulfate - answersDecreases salivary secretions, decreases trem