Pharmacology Final Exam Study Guide

1. Why do we do the 5 rights when giving medications? 2. How many patient identifiers do we need? 3. How do you give sublingual nitroglycerin 4. Benefit of giving a transder- mal patch? 1. right drug 2. right person 3. right dose 4. right route 5. right time To ensure patient safety We need 2 patient identifiers to ensure that it is the correct patient Have 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 Gives the medication a constant level, where the levels in the body do not fluctuate as much 5. Trough levels Lowest 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 6. What drugs do you draw trough levels for? Drugs that have a narrow therapeutic index 7. Therapeutic index Estimates the margin of safety for a drug using a ratio that measures the effective 8. What drugs do you draw peak and trough levels for? therapeutic dose in 50% of people and the lethal dose in 50% of people Closer the number to 1 the higher the like- lihood of danger Digoxin Aminoglycosides 9. What are peak levels Rate of absoprtion 10. If someone has reoccurring infections and they keep tak- ing antibiotics and they are no longer working what has hap- pened? They have developed acquired bacterial re- sistance 11. Onset of action Time it takes for a drug to reach the mini- mum effective concentration after a drug is administered (MEC) 12. How are drug doses per- scribed According 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 13. Half-life of a drug Time it takes for half of the drug concentra- tion 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 14. Benefits of using a generic drug? Cost effective 15. Who governs all drug admin- istration by nurses? 16. Native American view about time 17. What drugs are metabolized differently in African Ameri- cans and therefore are not as effective? Nurse practice acts: every state has its own laws They are concentrated about today, not to- morrow 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 discontin- ue meds after feeling better Antihyperstensive agents Beta blocker, and ACE inhibitors 18. Drug interaction Altered 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 19. If pt is taking a medication and starts taking an OTC drug as well and states that the pre- scription drug is no longer working, why is it no longer working? 20. Anti ulcer drug semeda- dine/tagment is a? 21. What type of interaction when taking semedadine and theo- phylline? Because of a drug interaction Hepatic enzyme inhibitor Used for ulcers Semedadine will make theophylline stay in the body longer so therefore the pt will need the dosage of theophylline lowered until tak- en off of semedadine 22. Characteristics of drug abuse Jittery, anorexia, tachycardia: speed Changes in personality, job performance, poor judgement, inappropriate behavior, er- rors, physical and emotional symptoms 23. How do you know when a smoker is ready to quit? 24. What should a person do be- fore taking herbs? 25. Feverfew should not be taken by whom? When they state that they are truly ready to quit Talk with their health care provider Woman who are pregnant 26. Babies have immature what? Hepatic and renal systems Meds stay in their bodies longer 27. Laws for children 2002: Best pharmaceutical for children act-- gave drug manufactures an exten- sion of their patent to evaluate drugs on the market for their safety and efficiency in children 2003: Pediatric research equity act--au- thorizes the FDA to require that drug manu- factures test drugs and biological products for their safety and effectiveness in children noting that children are NOT small adults 28. When dealing with an adoles- cent patient what do you want them to be able to do? 29. Geriatric considerations when prescribing medications Verbalize their feelings about a procedure whole body works slower: same with chil- dren: Decreased liver and kidney/ hepatic and renal function Lower albumin so drug cannot bind to pro- tein 30. 2 tests for the kidneys BUN & creatinine 31. What do you want elderly pa- tients to bring to their doctor visits List ad or all of their medications 32. People in a research study may do what at anytime? Stop or end their participation without penalty 33. What is phase 1 of a drug study Primarily designed to assess safety and the objective is to determine the human dosage range based on the response in healthy hu- man beings and to identify the pharmakoki- netics of the drug First they try the drug on healthy people without the disease Second on people with the disease 34. QSEN patient and family cen- tered care Pt as source of control full parter in provid- ing care that is compassionate and coordi- nated care based on respect for pt prefer- ences values and needs 35. Autonomy Pt as source of control 36. Collaboration and teamwork QSEN Function effectively in nursing and interper- sonal teams fostering open communication mutual respect and shared decision making to achieve quality pt care 37. NO If person is allergic to peni- cillins can you give them amoxicillin? 38. What can happens when azithromyacin is taken with other hepatic drugs such as acetaminophen and tylenol and diphenahydramine (be- nadryl) 39. What pt teaching is there for a pt who is taking sulfa drugs: sulfamenadines Bactrim and septrim 40. If a pt is taking bactrim and septrim and they get a vaginal infection why did they? 41. Who should take prophylactic anti tubercular therapy? The drug of choice is arithromy- ocin/azithromyacin Hepatotoxicity so you always need to check liver enzymes Increase fluid intake: several quarts/ forms crystals in urine/ kidney stones From a superinfection Sores in mouth, tongue, vaginal infections, (yeast infections) Individuals who have been in close contact with someone who have been in close con- tact with persons with TB 42. Why do we use 3 drugs to treat To decrease the likeliness of becoming re- TB? 43. What are the side effects of anthelmintics (worms) 44. Pt teaching for a person with worms or on anthelmintics 45. If someone has had trouble sticking to a medication regi- sistant to one of them All GI side effects Should administer after meals to avoid GI effects They should take a shower/ not a bath Wash hands before eating and after going to the toilet Give them written and verbal information about each drugs purpose men in the past what should the nurse do to prevent it 46. If you are working with peo- ple who have HIV and you get stuck with a needle what should you do? 47. Child on antibiotics for ear infection comes in after tak- ing all of the antibiotics for a wellness appointment can they get vaccines? 48. A mother asks if it is real- ly necessary for her 9 year old daughter to get gaurdasil what would you tell her? 49. Why are 2 agents often given with chemo drugs 50. What should a home health nurse wear when giving IV chemo? 51. Pt taking interferon alpha and they develop chills, fever, and malaise what should you do? 52. What is the blood test to make sure a pt is in heart failure and not COPD 53. If a pt has a patch you know they understand the teaching Get 4 weeks of antiretral viral therapy Yes Do not give until 1 week after antibiotics or if they currently have an infection Yes its better to get vaccinated before sex- ual intercourse Because they have a synergistic effect, they work better together Impermeable and disposable gown when hanging the drug Notify the provider and anticipate an order for tylenol Prior to giving the drug the nurse could administer acetaminophen and diphnhy- dromine BNP Rotate sites if they say they are going to do what? 54. What lifestyle changes can you make to avoid hyperten- sion 55. 80 year old taking thiazide for hypertension what should you do 56. Taking care of post op pt what do you give to prevent DVT formation Weight reduction and decrease sodium Tell them to sit up slowly Initiate fall risk protocall Low molecular weight heparin 57. If someone is taking heparin and they are bleeding a lot what do you get an order for? Protamide sulfate 58. Cholesterol level of 270 is High risk for coronary artery disease what? 59. If someone has been taking a Call the doctor because it is probably rhab- statin lipitor for a long time domyolysis and develops muscle weak- ness and tenderness what should you do? 60. Pt in ER Administer oxygen HR 98 crackles in lungs 02 93 what do you do first? 61. After first nitro everything Notify the doctor before giving another drops really low what should you do before giving another 62. Get a set of vital signs before calling the doctor Pt has rash and runny nose after eating strawberries what do you do? 63. Someone taking a nasal de- congestant too long and gets worst what should you tell them? If they stop taking it, then it will get better 64. Migraine headaches -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 65. Cluster headaches -Unknown cause, but generally considered to be caused by the hypothalamus activat- ing 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 66. What top two things should you avoid when you get clus- ter and migraine headaches? 67. What can access caffeine cause? -Chocolate -Caffeine -Seizures -Arrhythmias 68. What stage of sleep do dreams occur? 69. Many OTC sleep aids are anti- histamines (benadryl), if pt is taking a benzo for a prolonged time what should they be sure to do? 70. After a pt receives spinal anesthesia how long should they remain lying on their back for? 71. How long will pts with epilep- sy take anticonvulsants for? 72. Child comes into the hospi- tal with multiple seizures and is intibated what will you give them? 73. Pregnant woman with seizures what would you give them? 74. Person who has a shuffling gait, involuntary tremors of the limbs, and lack of facial ex- pression has what? And what would you treat this condition with? 75. What are the three cardinal symptoms of Parkinsonism? 76. Alzheimers -During the REM stage of sleep is when the most recallable dreams occur Tapper off of the medication slowly and not to just discontinue it abruptly 6-8 hours supine This is a medication that those with epilepsy will remain taking for the rest of their life Valume The condition is also referred to as status epilepticus Give her magnesium sulfate -1st line of action for a pregnant women who is having seizures and experiencing high blood pressure -Parkinsons -Carbadopa/levodopa -Rigidity -Tremors -Bradykinesia -Chronic, progressive, neurodegenerative condition with marked cognitive dysfunction -The cause is really unknown 77. Parkinsons Imbalance in dopamine and acetlycholine 78. What is the highest priority for an advanced Alzheimer's pt? 79. Myasthenia's gravis what symptoms would you worry about 80. Pt given mestinon and having severe muscle weakness, ex- cess salvation, pupil constric- tion, and fasciculation what would you do? -Assist the pt with care needs, ADL -Worry about their respiratory system and facial muscles Give the pt atropine 81. MS -Weakness of extremities -Double vision 82. What tests can detect MS -Cerebral spinal fluid -Aminoglobulin G -MRI 83. Cox 1 and Cox 2 #2 converts acid into chemical mediator for inflammation -Asprin inhibits Cox1 and Cox2 84. What are the cardinal signs of inflammation? 85. If you have a pt come in with bad pain what is the first thing -Redness(erythema) -Swelling(edema) -Heat -Pain -Loss of function Rate their pain on a scale of 0-10 that you are going to have them do? 86. Pt in PACU with several S/S, and has a morphine IV what is the #1 priority of this patient? 87. Who would you not want to give opioids to? 88. Who requires an increased amount of an opioid and it would be more so okay to do? 89. How do you administer IM hal- dol? 90. Pt comes in complaining that their prescription for ata- van(lorazepam) that they have been on for 6 months is not working well enough and why? 91. Pt comes in that has been on a medication for anxiety and de- pression and it is not working what would you tell them? 92. Pt who is taking zoloft c/o not sleeping well what would you do? 93. A pt who is taking efexir would want to stay away from what other type of medica- tion/herbal remedy? 94. Why are MAO inhibitors not prescribed anymore? Respiratory depression/problems Someone that has a closed head injury A cancer pt Z-track This pt has built up a tolerance to the med- ication The medication can take up to 2 weeks to become affective Ask the pt what time they are taking their medication St. Johns Wart This medication requires strict dieting, such as a lot of food restrictions 95. Pt comes in with signs of lithi- um overdose what would you do? 96. 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? 97. What is the best advice for a woman that comes in and is 2 months pregnant and is hav- ing N/V? 98. If a pt keeps having un- explained reoccurring vomit- ing episodes what would you give? 99. How can you tell a pt to pre- vent travelers diarrhea? 100. Pt comes in and says that the nexium that they were pre- scribed it working very well what would you tell them? 101. If a pt has Zollinger Ellison what shouldnt they take? 102. Pt is taking zantak for a peptic ulcer and c/o not feeling any better what would you do? 103. Eye drops are administered prior to an eye exam, when can the exam then begin? Get an order to check their lithium drug level 8:30 With this medication you want to take it 30 minutes before Tell the pt to eat saltine cracker, this route is safer for the baby You would want to get an order to adminis- ter IV fluids and electrolytes You would tell them to make sure and drink lots of bottled water and to only ingest meats that are very well cooked To keep taking the medication for another 4 weeks Sedmedadine (tagament) Tell them to take at least 2 more weeks of the medication in order to feel better When there is an absence of a blink reflex 104. Timalol eye drops are given to a pt for glaucoma how would you prevent bradycardia from occurring? 105. An adolescent who is a life guard gets external otitis how would you tell them that they can prevent this from happen- ing? 106. Pt comes in with acne what would you tell them to do? 107. What should you test a pt for before giving them a prescrip- tion for Enbrel? 108. Pt is putting silvadine on their burns and is experienc- ing burning after doing this what is the reasoning? 109. What is the name of the pepsin inhibitor that coats the gastric lining of the stomach? You would push on the lacrimal ducts After being in the water they should dry their ears with a hair dryer Cleanse the skin GENTLY several times per day Test the pt for TB Burning is an expected adverse reaction of the medication sucralfate (Carafate) 110. Growth hormone Acts only on newly forming bones before the epiphyses plates fuse. 111. What route must growth hor- mone be given? SubQ or IM 112. Growth hormone therapy Can either replace or inhibit GH Can really mess with insulin in your body, leading to diabetes. (Effects BS) 113. Somatotropin Helps children who have a growth deficien- cy Kids that are obese or have resp problems should not take 114. Acromegaly Excessive growth after puberty Caused by excessive secretion of GH or from a tumor 115. What is acromegaly treated with? Octreotide or Bromocriptine mesylate 116. Octreotide Suppresses GH release Can be used alone or with surgery and radiation S/E: GI effects Also used for excessive diarrhea from tu- mors 117. Bromocriptine mesylate Suppresses and decreases GH levels but also decreases lactation and prolactinoma 118. Levothyroxine sodium Increases T3 and T4 Treats goiter and Hashimoto 119. Liothyronine RAPID ONSET!! Used frequently as initial therapy for Myxedema. Short half life/works fast 120. Liotrix Combination thyroid medication of levothy- roxone and liothyronine 121. SE: if you get too much thry- oid medication? 122. N/V Tremors Headache Weight loss Tachycardia Hypertension Palpitations What are the types of dia- betes? Type 1 Type 2 Secondary diabetes Gestational diabestes 123. Type 1 Occurs at a young age Can get it from a viral infection or environ- mental conditions Your body does NOT produce insulin 124. Type 2 MOST COMMON Caused from heredity and obesity Body makes some insulin 125. Secondary Diabetes Occurs temporarily in pre-diabetic patients taking certain medications 126. Gestational diabetes Occurs during the 2nd and 3rd trimesters of pregnancy. Hormone levels will increase during this time inhibiting the body's insulin usage 127. Before calling a physician what do you want to be sure and do? Get a complete set of VS 128. Pnemothorax When you puncture the lung S/S: sharp chest pain, decreased breath sounds 129. Air embolism S/S coughing, SOB, chest pain, cyanosis 130. All types of diabetes are marked by what same 3 key symptoms? 131. Pt comes into the ER uncon- scious what should you do? 1. Polyuria 2. Polydipsia 3. Polyphagia Give 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 132. What is the only type of insulin Regular insulin that can be given through an IV? 133. What vitamin is important dur- ing pregnancy? Folic acid Important for neural development Prevents spinabifida 134. Water soluble vitamins Do not get stored in the body Gest excreted readily Vitamins B and C 135. Fat soluble vitamins Get stores in fatty tissue, liver, and muscle Slowly metabolize Vitamins D,A,K,E 136. Vitamin C Primarily found in veggie bruger. In citrus fruits and green veggies 137. Vitamin D Taken with calcium Helps to reduce fractures Required for calcium absorption 138. Lactated Ringers Solution Purpose is for hydration and electrolyte re- placement. Do not give to a pt with liver disease Replenishes fluid volume 139. Normal sodium level . Normal potassium level 3.5-5.0 141. Thiazide diuretic Causes hypercalcemia, hyperglycemia Interacts with DIGOXIN Used for hypertension and edema 142. Kayexalate Used for SEVERE hyperkalemia. May cause hypocalcemia, hypomagnesium Retains sodium 143. Normal saline 0.9% An isotonic solution used for hydration Should not be used for long periods of time 144. Enteral Nutrition Involves GI tract Can be given orally or via tube feeding 145. What assessments would you do before enteral feeding? 146. What is a potential complica- tion with TPN? Check for distended abdomen, listen for bowel sounds Ask pt about last BM Air embolism It can be prevented by closing clamps 147. Aspiration pneumonitis Complication of enteral feeding Occurs if pt is lying down while getting the feeding Pt must be sitting up 148. Bethanechol chloride Urecholine Used 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 149. Atropine sulfate Decreases salivary secretions, decreases tremors in pts with parkinson's Increases heart rate during bradycardia Causes dry mouth, and thats a way you know its working pt C/O 150. What is used to treat a bethanechol overdose? 151. What is the primary drug used for Parkinson's 152. Benztropine Atropine sulfate Benztropine 153. What can alter urines pH and make it stay acidic? 154. What is the normal amount of urine output? 155. What are the 2 lab tests to check for kidney function? 156. What should be done before starting a pt on drugs to treat a UTI? Anti-cholerginic Decreases involuntary movement & dimin- ishes S/S of tremors and muscle rigidity Cranberry juice 30 ml/h BUN & Creatinine Complete a culture and sensitivity test 157. Acute pyelonephritis Upper UTI: in the kidney's 158. Acute cystitis Lower UTI: in the bladder 159. Prostatitis What males most likely have when they get same symptoms as acute cystitis Can be caused be a vineral disease or an enlarged prostate 160. Furosemide Used to treat fluid retention Inhibits sodium and water reabsorption so it excretes both. Gets excess fluid off of a pt QUICK! Drug interaction with Diamox 161. Parasympathetic Nervous System Speeds up peristalsis and urination while slowing everything else down 162. Sympathetic Nervous System Slows down peristalsis and urination while speeding everything else up 163. Nitrofurantoin Urinary antiinfective medication Used to treat acute & chronic UTI's 164. Adverse reaction to Diamox Hyperglycemia Can cause F&E imbalances and orthostatic hypotension 165. Diamox Medication used to treat narrow angled glaucoma 166. Progestin Hormone that acts like progesterone 167. How does progestin prevent pregnancy from occuring By inhibiting ovulation (causes anovulatory cycle) Suppresses LH surge which prevents ovu- lation No endometrium is then shed 168. Breakthrough bleeding Bleeding that occurs during the active pill cycle of birth control products Usually at the start of taking BC & when taking progestin-only meds 169. Mircette 28 day BC Supplies estrogen during the "inert" phase of the pill cycle Provides greater degree of ovulation sup- pression and helps pts that get headaches during periods 170. Depo-Provera Injection Highly effective, long lasting injectable progestin Given every 11-13 weeks No periods and lack of ovulation Injection site should be rotated 171. Flutamide (eulexin) Nonsteroidal antiandrogen drug used to treat metastatic prostate cancer 172. Tadalafil Used to treat erectile dysfunction Interacts with grapefruit products S/E: blurry vision, light sensitivity Pts taking nitrates should NOT TAKE THIS MED 173. Primary amenorrhea No period by age 14 without secondary sex characteristics or no period by age 16 with secondary sex characteristics May be caused by abnormalities in the girl's reproductive tract: physiological delay 174. Secondary ammenorrhea No period for 6 consecutive months in woman who have had periods before Pregnancy is the most common cause Normal maturation 175. How to evaluate amenorrhea? First do a pregnancy test Progestational challenge test: proges- terone is given to pt through medication. When it is discontinued it causes withdrawl bleeding which is considered positive test that indicates cycle is functional in providing hormones to regulate a period NOT for ppl with peanut allergies 176. PCOS Polycistic ovarian syndrome: causes sec- ondary amenorrhea. Insulin resistance is a hallmark of PCOS LH is over secreted which forms several fol- licular cysts instead of one dominant follicle Ovulation does not occur 177. How to treat PCOS Can be treated with estrogen-progestin combination contraception that suppress LH and FSH secretion For woman who want to get pregnant met- formin and clomiphene citrate are used 178. Glucophage (metformin) A biguanide compound Decreases glucose production from stored glycogen so it lowers serum glucose after a meal Control hyperglycemia, regulates menstru- al period. Not recommended for pts with renal prob- lems 179. Gardisal vaccine Is a recombiant vaccine for HPV First vaccine designed to prevent cancer Contains 4 strains of HPV virus Administered in 3 shot series to females and males 9-26 years of age. Most effective if given before having sex