Pharmacology Quizzes

Pharmacology Quizzes When the nurse considers timing of a drug dose, which factor should they consider when deciding when to give the drug? - The patient's last meal Patient's with liver failure would most likely have problems with which pharmacokinetic phase? - Metabolism A drug's half-life is? - The time it takes for one half of the original amount of the drug to be removed from the body Drugs affected by first pass effect - orally administered drugs. *Sublingual, IV meds, and injections ARE NOT effected What is true of OTC drugs? - -May delay treatment of serious ailments -May relieve SX without addressing the cause of the problem -Labels can be easily misunderstood and taken improperly When a patient is taking an anti-cholinergic such as benztropine as part of TX for Parkinson's disease, what should be included in the teaching plan? - Use artificial saliva, sugarless gum, or hard candy to counteract dry mouth Anti-cholinergic drugs should be taken when? - With or after meals -to minimize GI upset. Patient must consume at least 3,000 mL of fluids/day to prevent constipation. What is the counter-indication of taking herbal therapies during SSRI therapy? - Can cause severe interactions such as confusion, agitation, muscle spasms, twitching, and tremors. What is the priority concern for a tricyclic anti-depressant overdose? - Cardiac dysrhythmias. -second priority would be seizures SSRI's and TCA's both function by which mechanism? - Blocking the re-uptake of neurotransmitters at nerve endings. -SSRI's block re-uptake of serotonin -TCA's block re-uptake of nor-epinephrine AND serotonin. Cholinergic (parasympathomimetic) drugs have what therapeutic effect? - Increased GI motility What is the expected therapeutic action of Donepezil (Aricept)? - To increase levels of acetylcholine in the brain by blocking its breakdown. *Used to treat Alzheimer's. *Donepezil is an indirect-acting anti-cholinesterase drug. Nursing Implications for Donepezil (Aricept) - -Take late in the evening -Start low and go slow -Atropine is antidote if cholinergic crisis occurs -Assess for urinary obstruction especially in older men Adverse effects of methylphenidate include? - Increased heart rate, hypertension, angina, anxiety, tremors, blurred vision, GI distress, worsening or new onset of psychiatric SX. Weight loss, headache, insomnia. To reduce the GI effects of Orlistat (Xenical), what will the nurse encourage the patient to do? - Limit dietary intake of fat to less than 30% of total calories. *Orlistat blocks the absorption of fat from the GI tract. Limiting fat intake reduces the side effects (flatulence, oily spotting, fecal urgency). What is the "wearing-off" phenomenon? - Occurs when anti-parkinson medications start to lose their effectiveness as the disease progresses. What is true regarding the use of Benzodiazepines while taking Levodopa? - Benzo's decrease the therapeutic effect of the Levadopa and may result in an increase of Parkinson symptoms. What is the goal of Parkinson's disease therapy? - To balance cholinergic and dopaminergic activity in the brain. *Since parkinson's disease results from a decrease in dopaminergic activity, that leads to too much cholinergic activity. By increasing dopamine, the neurotransmitter activity becomes balanced and symptoms become controlled. What is the action of Carbidopa-Levodopa (Sinemet)? - Carbidopa decreases levodopa's conversion in the periphery, increasing the levodopa available to cross the blood-brain barrier. What information about diet should the nurse teach a patient taking Levodopa? - Avoid taking with high-protein foods. *High-protein foods decrease the effects What are the 3 antiepileptic drugs? - -Phenytoin (Dilantin) -Carbamazepine (Tegretol) -Valproic Acid (Depakene) What should you watch for in a patient taking Dilantin? - Cognitive impairment, hypotension, gingival hyperplasia, bradycardia, rash What should you watch for in a patient taking Tegretol? - Ataxia, vertigo, visual problems, leukemia, anemia, thrombocytopenia What should you watch for in a patient taking Valproic acid? - GI upset, hepatotoxicity, pancreatitis What are nursing implications for anti-epileptic drugs? - -Usually given orally. -Do not mix IV Dilantin with other meds. Administer slowly (don't exceed 50mg/min). -Perform periodic blood studies and therapeutic levels. -Check hepatic and renal functions. -Do not give Tegretol with grapefruit juice. -With Dilantin, suggest taking 0.5 mg of folic acid daily. -With Dilantin, instruct to take with meals. SSRI's - -Fluoxetine (Prozac) -Paroxetine (Paxil) -Sertraline (Zoloft) -Fluvoxamine (Luvox) -Escitalopram (Lexapro) -Citalopram (Celexa) What are nursing implications for SSRI's? - -Not recommended for use during pregnancy or lactation -Bleeding problems may occur if taken concurrently with anti-coagulants or NSAID's. -Monitor for mood changes (increased risk for suicide) MAOI's - -Nardil (phenelzine) -Parnate (tranylcypromine) -Marplan (Isocarboxazid) -Emsam (Selegiline) Nursing Implications for MAOI's - -Avoid OTC drugs, especially cold remedies, nasal decongestants and asthma medications. -Avoid tyramine-rich foods -Avoid chocolate and caffeine -Hypertensive crisis can be triggered by tyramine rich foods and medications containing diuretics, antihistamines, antihypertensives, and ephedrine. What are the drug trial categories that are OK for pregnancy? - Categories A & B What drug trial categories are "iffy" for pregnancy? - C & D however, benefit outweighs risk for some situations What is a prototype drug within a drug class? How is this important to learning medications? - -Can be compared to all other medications of the same class. -Importance: Easy to predict adverse effects of all drugs in the class Pharmacodynamics - What a drug does to the body. (Stimulating or slowing a certain hormone, etc). Pharmacokinetics - HOW the body absorbs a drug. (how it moves, excretion, etc). Pharmacokinetics effect which actions? - -onset of drug action -drug half-life -timing of peak effect -duration of drug effects What labs should you look at to monitor excretion of a drug? - Kidneys --> BUN & Creatinine levels How are drugs excreted? - Saliva, skin, lungs, bile, feces Phase 1 clinical trials - tightly controlled study using healthy humans as volunteers Phase 2 clinical trials - drug is administered to patients who have the disease in which the drug was intended to treat Phase 3 clinical trials - drug is used in a clinical setting to determine any anticipated effects or lack of effectiveness Phase 4 clinical trials - post marketing surveillance. this phase involves continual evaluation of the drug following approval for marketing FDA Approval - drugs that complete phase 3 are evaluated by the FDA after submission of a NDA (new drug application). If approval is received, drug may be marketed. Schedule I Drugs - -high abuse potential, no accepted medical use Ex.) heroin, cocaine Schedule II Drugs - -high abuse potential with severe dependence liability Ex.) opioids, amphetamines, barbiturates Schedule III Drugs - -less abuse potential than schedule II, moderate dependence liability Ex.) non-barbiturate sedatives, non-amphetamine stimulants, limited amounts of certain opioids Schedule IV Drugs - -less abuse potential than schedule III, limited dependence liability Ex.) some sedatives, non-opioid analgesics, anti-anxiety agents Schedule V Drugs - -limited abuse potential Ex.) drugs that may contain small amounts of opioids such as codeine, used as anti-tussives or anti-diarrheals Pharmacotherapy/Pharmacotherapeutics - Application of drugs for the purpose of disease prevention and the treatment of suffering Bioavailability - the measure of the extent of drug absorption for a given drug and route from 0% to 100% Bioequivalent - when 2 medications have the same bioavailability and the same concentration of active ingredient Ex.) A trade name drug and a generic drug Agonist - drugs that cause the same activity that natural chemicals would cause at the receptor site Antagonist - drugs that bind to the receptor site and inhibits the activity at that receptor site Onset of Action - the time required for a drug to elicit a therapeutic response after it is given Peak Effect - The time required for a drug to reach its maximum therapeutic effect in the body Duration of effect - the length of time the concentration of a drug in the blood or tissues is enough to elicit a response Biotransformation - occurs in the liver and changes the drug into a new less active more specific chemical. First Pass Effect - the initial metabolism of a drug. Drug is taken PO, absorbed from GI tract and then metabolized in the liver. The drug is then circulated to the blood stream What should you be cautious of when administering medications? - -Patients with liver disease. *Drugs won't be metabolized correctly What should you always monitor when using drugs with first pass effect? - Liver enzymes on CMP If oral medications are affected by the presence of food or stomach acid, when should you give it? - 1 hour before meals or 2 hours after What are some factors that influence the effect of a medication? - -Weight -Age -Gender (Men are more vascular, drug effects are seen quicker. Women have more fat, fat soluble drugs stay in system for longer) Site of action for First Generation anti-psychotic drugs - block dopamine/histamine receptors Site of action for second generation anti-psychotic drugs - block serotonin/dopamine receptors Peripheral Nervous System side effects of anti-psychotics - Constipation, dry mouth, congestion, blurred vision, urinary hesitation, weight gain Central Nervous System effects of anti-psychotics - Dystonias, seizures, drug-induced parkinsonism, tardive dyskinesia, restlessness What are the most common adverse effects from antidepressants? - Orthostatic hypotension, sedation, cardiac toxicity, seizures, hypomania, sexual dysfunction How often should blood be drawn during lithium therapy? - -Every 2 days during therapy -12 hours after afternoon dose -1-3 months after therapy What is the reversal agent for Benzodiazepines? - Flumazenil Medications used to treat EPSE's - -Anticholinergics (Benztropine, trihexyphenidyl) -Antihistamines (Diphenhydramine) -Dopamine Agonist (Amantadine) With agranulocytosis, what should the nurse monitor? - WBC count weekly. If less than 3,500 - no TX. When TX is started, if WBC drops below 3,000, stop TX and monitor for infection. Agranulocytosis is most common with what medication? - Clozapine How should you assess for Tardive Dyskinesia? - AIMS Scale. If a patient is experiencing tardive dyskinesia, what medication is contraindicated? - Anticholinergics - Worsening SX What are the 3 common mood stabilizers? - Lithium, Carbamazepine, valproic acid What are adverse effects of Lithium? - drowsiness, slurred speech, epilepsy-type seizures, ataxia, hypotension, involuntary movements What can long-term lithium therapy cause in a patient? - Hypothyroidism What is another name for anti-anxiety medications? - Benzodiazepines (suffix: -lam, -pam) Do not give anti-anxiety meds if: - patient has elevated BP, hx of drug abuse, renal/hepatic dysfunction 3 D's to expect from anti-anxiety medication - Drowsiness, dizziness, decreased BP What is the action of benzodiazepines? - depress activity in the brainstem and limbic system (Alprazolam, diazepam, lorazepam) Most common benzodiazepine? - Alprazolam Nonbarbiturates sedative-hypnotics are treatment for what? - Short term TX of insomnia, muscle cramps/spasms, anxiety Most common nonbarbiturate sedative-hypnotic? - Ambien What is a nonstimulant used to treat obesity? - -Stritera -Orlistat What are the actions of adderall? - -Norepinephrine from nerve endings is released -Decrease fatigue in narcolepsy -CNS & respiratory stimulation -increase motor activity and alertness *Most commonly used for ADHD What is the main therapeutic use of Anti-Parkinson's drugs? - the ability to perform ADL's. *Important: These drugs do not halt progression of the disease What should a patient avoid while taking anti-parkinson drugs? - High protein meals and snacks 8 D's of domaminergics - -Dizziness/Drowsiness/avoid Driving -Dyskinesias/Dreams (nightmares) -Decrease in reality (hallucinations) -Decrease in BP (orthostatic hypotension) -Decrease protein diet, eat shortly after taking med -Decrease Pyridoxine -Discoloration of sweat and urine - harmless -Decrease dry mouth w/ good hygiene Common dopaminergics used to treat Parkinson disease - -Carbidopa-Levodopa/Levodopa -Selegiline -Rasagiline Common dopamine agonists used to treat Parkinson disease - -Apomorphine -Bromocriptine -Pramixpexole -Ropinirole hydrochloride Common anticholinergics used to treat Parkinson disease - -Atropine sulfate -Benztropine mesylate -Diphenhydramine -Glycopyrrolate -Hyosxyamine sulfate -Propantheline bromide -Scopolamine hydrobromide -Trihexyphenidyl What are some nursing implications for a patient receiving Carbidopa/Levodopa? - Monitor BUN, hct/hgb, WBC, AST, ALT, serum glucose