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pharmacology > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

90% of nursing time is spent doing what 3 things?

A
  • assessing patients
  • supervising unlicensed people
  • administering medications
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2
Q

5 core aspects of medication knowledge

A
  • classification
  • safe dose range
  • correct method of administration
  • expected therapeutic effects
  • adverse effects
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3
Q

controlled drugs I-V

A 
I: LSD, heroin
II: Narcotic analgesics
III: sedatives, anabolic steroids
IV: sedative - hypnotics
V: Partially controlled: Lomotil
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4
Q

pharmacotherapeutics

A

the desired therapeutic or beneficial use of the drug

“off label” use

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5
Q

pharmacokinetics - 4 components

A

I. absorption
II. distribution
III. biotransformation
IV. excretion

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6
Q

3 key factors for absorption

A
  1. route of administration
  2. drug solubility and concentration
  3. site conditions
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7
Q

serum half-life

A

the time it takes for the serum concentration of a drug to decrease by 50%

  • depends on rate of metabolism and excretion
  • short half life = more frequent administration
  • may take 4-5 doses for equilibrium
  • max therapeutic effect occurs with equilibrium
  • hepatic and/or renal failure may lengthen the half life
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8
Q

medication effects: therapeutic (6 components)

A
  • palliative
  • curative
  • supportive
  • substitute
  • chemotherapeutic
  • restorative
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9
Q

drug effects on the fetus (ABCDX)

A

A: studies done on pregnant women: no risk
B: animal studies: no risk
C: animal studies - potential risk (take only if benefits outweigh the risks)
D: evidence of human fetal risk
X: Risk outweighs any potential benefit

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10
Q

characteristics of autonomic drugs

A
  • either stimulate or block the SNS or PSNS
  • effect the entire body
  • effect depends on which branch of ANS is stimulated or blocked
  • drugs are being designed to stimulate or block very particular receptors
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11
Q

What OTC drug category should be avoided/used cautiously with people that have hypertension anima?

A

Adrenergic

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12
Q

Drug category that can decrease nasal congestion by way of vasoconstriction?

A

Adrenergic

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13
Q

Drug that stimulates both Alpha and Beta?

A

Epinephrine (adrenergic)

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14
Q

Drug that blocks both Beta 1 and Beta 2?

A

Propanerolol

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15
Q

If the patient is bradycardic and fatigued?

A

Alpha and beta blockers

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16
Q

If I tell you the patient is having cardiac arrhythmias and hypertension?

A

Adrenergic or anticholingerics

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17
Q

Dry mouth tachycardia urine constipation

A

Anticholinergic

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18
Q

Teach the patient to increase their fiber and fluid?

A

Anti-cholinergic (think DRY)

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19
Q

What category of drug do we keep the patient from stopping abruptly?

A

Beta Blockers

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20
Q

What drug might produce Tachycardia and Hypertension?

A

Anticholingeric and beta 1

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21
Q

What two categories of drugs would we cause for potential bradycardia and hypotension?

A

Cholingeric and anti-adrenergic (Alpha and Beta)

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22
Q

Stimulation of the alpha 1 receptors?

A

Peripheral Vasoconstriction

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23
Q

3 things that occur with blockage of Beta 1 receptors?

A
  1. Decrease in heart rate
  2. Negative inotropic
  3. Negative dromotropic
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24
Q

Simulation of cholinergic receptors?

A

Decreased heart rate, increased secretions, increased salivate, GI secretions, GI motitlity, release of sphincters, more sweating, urinations (think WET)

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25
Q

What 2 things happen when you give a medication that stimulates Beta 2 receptors?

A
  1. Bronchodilatation

2.

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26
Q

What 3 things happen when you give a medication that stimulates Beta 1 receptors?

A
  1. Positive chronotropic (increased heart rate)
  2. Positive inotropic
  3. Increased dromotropic
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27
Q

What is the first line of drug for treating bradycardia?

A

Anticholinergic

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28
Q

What category of autonomic would you give for patient with myasthenia gravis (skeletal muscle weakness)?

A

Cholinergic

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29
Q

For patients that have hypertension, what category of Autonomic drug would be best?

A

Anti-adrenergic (either alpha blockers or beta blockers – recommended as first line for heart issues/hypertension)

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30
Q

For a patient that has asthma and COPD, what category of autonomic drug might be best?

A

Adrenergic (prototype: epinephrine)

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31
Q

Opioid Agnoist prototype

A

Morphine

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32
Q

Opioid Agonists/antagonists prototype

A

Pentazocin (Talwin)

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33
Q

Opioid Antagonist prototype

A

Naloxone (Narcan)

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34
Q

Treatment of opioid withdrawal prototype, other option

A 
Methadone
Buprenorphine (suboxone)
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35
Q

Acetylsalicylic acid prototype

A

Aspirin

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36
Q

NSAID prototype

A

ibuprofen (advil)

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37
Q

Acetaminophen prototype

A

Tylenol

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38
Q

Cox-2 inhibitor prototype

A

Celecoxib (Celebrex)

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39
Q

Barbiturates prototype

A

Phenobarbital

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40
Q

Benzodiazepine prototype

A

Diazepam (Valium)

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41
Q

Benzodiazepine antidote

A

Flumazenil (Romazicon)

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42
Q

Miscellaneous sedative/hypnotic anti-anxiety prototype

A

buspirone (Buspar)

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43
Q

Sedative-Hypnotic prototype

A

zolpidem (Ambien)

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44
Q

Catecholamines prototype

A

epinephrine (Adrenalin)

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45
Q

Non-catecholamines prototype

A

ephedrine

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46
Q

Alpha Adrenergic blocker - prototype

A

prazosin (Minipres)

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47
Q

Beta Adrenergic blockers - prototype

A

propranolol (Inderal)

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48
Q

Cholinergic prototype

A

Neostigmine (Prostigmine)

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49
Q

Anticholinergic prototype

A

Atropine

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50
Q

Absorption, distribution, and excretion may be decreased by:

A

Hypotension

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51
Q

Which one of the following would you NOT include in your teaching plan for your patient on Demerol (opiate)?

A

Bland, low residue diet

52
Q

Aspirin has been ordered for all of these patients seen today in the Emergency Department. Which one of the following patients should be given the aspirin without questioning the order?

A

An adult patient who came in with an elbow injury and resulting tendonitis.

53
Q

For which of the following reasons should a prescribed Valium dose be held?

A

If the patient is lethargic and drowsy

54
Q

Your patient has a preoperative order for Atropine 0.4mg IM. This medication has the same effect on the human body as:

A

Inhibiting the PSNS

55
Q

Which one of the following medication effects is NOT found in acetaminophen?

A

Anti-inflammatory

56
Q

Inderal is contraindicated in a patient with:

A

Obstructive airway disease

57
Q

When a patient uses a beta 2 agonist bronchodilators, such as Bronkosol, you will assess for the possibility of:

A

Tachycardia

58
Q

Your patient has a Dopamine (adrenergic) drip infusing via the left antecubital vein. While assessing him, you notice his IV has infiltrated. Your priority intervention is to:

A

Stop the Dopamine drip

59
Q

Your patient with Myasthenia Gravis is being treated with Neostigmine (Phyostigmin). An adverse effect to assess for is:

A

Diaphoresis (sweating)

60
Q

Which of the following metabolic effects may be a consequence of Epinephrine (Adrenalin) administration?

A

Hyperglycemia

61
Q

Orthostatic hypotension

A

a change in BP of > 15 mmHg from lying to sitting or sitting to standing

62
Q

Vasoconstriction

A
  • constriction of the blood vessels

- can lead to HTN (hypertension) and ↑ CO (cardiac output)

63
Q

Vasodilatation

A
  • blood vessels dilate

- can lead to hypotension

64
Q

Catecholamine

A

Adrenergic agonists (activate the Adrenergic receptors) that cannot be taken orally, have a brief duration, and cannot cross the BBB

Main types are: dopamine, norepinephrine, epinephrine

65
Q

Non-catecholamine

A

Adrenergic agonists (activate the Adrenergic receptors) that don’t contain the catechol nucleus but still activate the A and B receptors (indirectly or directly)

  • can be taken orally
  • longer lasting
  • can cross the BBB

Ex: ephedrine, amphetamine
Decongestants – pseudoephedrine
Diet pills – ephedrine
Asthma treatment - Beathine

66
Q

Inotropic – effect on the force of cardiac contraction

A

“+” or positive inotropic effect → ↑ in force of heart contraction

“-“ or negative inotropic effect → ↓ in force of heart contraction

67
Q

Chronotropic – effect on the heart rate

A

“+” or positive chronotropic effect → ↑ in heart rate

“-“ or negative chronotropic effect → ↓ in heart rate

68
Q

Nursing Interventions for Adrenergics

A
  • Set of VS before, during, and after administration
  • Promote sleep
  • Frequent bathing
  • Small frequent meals
  • For IV infusions
69
Q

Nursing Diagnoses: Adrenergics

A
  • Ineffective airway clearance
  • Decreased C.O.
  • Ineffective breathing pattern
  • Altered tissue perfusion
  • Sleep pattern disturbance
  • Anxiety
  • Potential for injury
  • Alteration in comfort
70
Q

adverse drug effects of epinephrine

A
  • tachycardic arrhythmias
  • Angina, CAD
  • Hypertension
  • Cerebral vascular disease
  • Common ADE: Anxiety, nervousness, insomnia
71
Q

epinephrine contraindications

A
  • tachycardic arrhythmias
  • Angina
  • Hypertension
  • Cerebral vascular disease
  • Allergy to the medication
72
Q

use epinephrine cautiously in patients…

A

with anxiety, insomnia, psych disorders, elderly

73
Q

Non-catecholamines (characteristics, examples)

A

act the same as catecholamines, but effects last longer and are effective orally, OTC medications available (though this can be dangerous)

Examples:

  • Ephedrine
  • Albuterol (Proventil, Ventolin)
  • Pseudoephedrine (Sudafed)
  • Terbutaline (Brethine)
74
Q

Endogenous catecholamines (ADRENERGICS)

A

Prototype: epinephrine (Adrenalin)
Norepinephrine
Dopamine

Used in emergency treatment:
Cardiac arrest
Hypotension
Shock
Bronchial asthma
Obstructive pulmonary disease
75
Q

Exogenous catecholamines (ADRENERGICS)

A

Isoproterenol (Isuprel)
Dopamine (Dobutrex)

Used in emergency treatment:
Cardiac arrest
Hypotension
Shock
Bronchial asthma
Obstructive pulmonary disease
76
Q

Adrenergic effects: B1

A

heart rate

77
Q

Adrenergic effects: B2

A

Bronchi, Feelings, increased Blood sugar, increased Fatty acids

78
Q

Adrenergic effects: A

A

Blood vessels, pupils, GI system, increased sweating, increased coagulation

79
Q

Alpha adrenergic receptors

A

predominantly effects the extremities: arms and legs
Peripheral vasoconstriction in the arms and legs

  • Prototype: prazosin (Minipress)
  • Alpha 1: act primarily in the skin, mucous membranes, intestines, kidneys to prevent adrenergic mediated vasoconstriction, can improve urinary flow by relaxing the sphincter
  • Lower blood pressue
  • If clinical use is treatment of hypertension, the common adverse effect could be hypotension (signs: lethargy, weakness, etc.)
  • Serious ADE – to avoid this, give it as the last thing before bed (generally always given at bedtime)
80
Q

Beta 1 adrenergic receptors

A

effect the cardiac (heart)

  • increased HR (positive chronotropic)
  • increased force of contraction (positive inotropic)
81
Q

Beta 2 adrenergic receptors

A

effects the lungs

- Bronchodilation

82
Q

Effects of adrenergics

A
  • Raise heart rate (+ chronotropic), force of contraction (+ inotropic), rate of the AV node (+ dromotropic)
  • Vasoconstriction, increase BP + CO, increased blood flow to the brain, heart (2 most vital organs to preserve) and skeletal muscles
  • Bronchodilation
  • Dilated pupils (mydriasis)
  • Subjective feelings of tensions
  • Decreased GI activity
  • Increased blood sugar
  • Glycogenolysis – breakdown of glycogen to form glucose
  • Gluconeogensis – making glucose from non-carbohydrate sources (fat + protein)
  • Increased fatty acids
  • Increased sweating
  • Increased blood coagulation
83
Q

Adverse effects of adrenergics

A
  • Tachycardia, arrhythmias, palpitations
  • Looks pale, feels cool, hypertension (HTN)
  • Restlessness, tremors, insomnia
  • May lead to nausea/vomiting, anorexia, constipation, ulcers, GI bleeding
  • Increased FBS, increased insulin needs for diabetic pts
  • Increased lipids (cholesterol)
  • Fluid loss, sweaty/clammy
  • Increased risk of MI and stroke
84
Q

Anti-cholinergic

A

Cholinergic blockers
Parasympatholytic

Same effect as blocking (inhibiting) the PSNS
Prototype: Atropine

THINK DRY

85
Q

Cholinergic

A

Parasympathominetic

Same effect as stimulation of the PSNS
Prototype: Neostigmine (Prostigmine)

  • 90% of the PSNS fibers are in the vagus nerve
  • 2 ways that cholinergic medications can work
  • some mimic the action of acetylcholine – they have rather limited use, but highly varied use
  • used to relieve urinary retention

THINK WET

86
Q

Anti-Adrenergic or adrenergic blockers

A

Same effect as blocking (inhibiting) the SNS

87
Q

Adrenergic

A 
Adrenergic agonists (Alpha-adrenergic agonists, Beta-adrenergic agonists)
Sympathomimetic

Same effect as stimulation of the SNS
-Prototype: Epinephrine (adrenalin)

88
Q

Potential adverse effects of Anti-Adrenergics or Alpha/Beta Blockers

A
  • Bradycardia
  • Hypotension
  • Orthostatic or postural hypotension (from laying to sitting, a drop in systolic pressure of more than 20 mm Hg or more in less than 3 minutes)
  • Fatigue, lightheadedness, pale, decreased level of consciousness, feelings of weakness, lethargy, depression
  • Shortness of breath (SOB)
89
Q

When you are taking care of any patient on cholinergic or anti-cholinergic medication, note the following 4 things

A
  1. these drugs impact places outside the specific location
  2. know exactly why the patient is taking it
  3. know what other medications the patient is taking
  4. the higher the dose, the longer the patient takes it, the greater the adverse effects
90
Q

5 ways opiates are given

A

PO (mouth)

IM (intramuscular)

IV (intravenous)

Patch

PCA (patient controlled analgesia)

91
Q

Opiate agonists (6)

A
  1. morphine
  2. demerol
  3. codeine
  4. dilaudid
  5. fentamyl
  6. oxycodone
92
Q

Opiate antagonists

A

Naloxone (narcan)

93
Q

Opiate agonists/antagonists prototype

A

Pentazocine (Talwin NX)

94
Q

3 most common clinical uses of opiates

A
  1. relief of moderate to severe pain
  2. acute pulmonary edema
  3. severe nonproductive cough

CAUTION:

  • respiratory depression
  • chronic lung disease
  • increased intracranial pressure
95
Q

therapeutic effects of opiates

A

interferes with pain impulses = decreased level of pain

96
Q

adverse effects of opiates

A
  • depresses CNS (sedation, dizziness, decreased resp. more serious)
  • depresses GI tract (N/V, constipation)
  • alters psychological responses to pain
  • produces euphoria
97
Q

3 categories for pain management

A
  1. opiates/opioids
  2. nonopiates: acetaminophen, salicityates (ASA, NSAID)
  3. adjuvant: benzo, corticosteroids
98
Q

Don’t use beta blockers with a patient who has…

A

Asthma

99
Q

endogenous pain relief

A

a system of opioid peptides: endorphins, serotonins, GABA

activated by exercise, massage, visualization, prayer, meditation, therapeutic touch

100
Q

exogenous pain relief

A

morphine-like drugs that bind to opiate receptors in the CNS

101
Q

acetaminophen-induced hepatotoxicity (signs, symptoms, treatment)

A

1-24 hours post: N/V, diaphoresis, malaise

24-48 hours post: decreased urine output, pain in the RUQ abdomen

2-6 days post: encephalopathy, renal failure, ecchymosis, jaundice, elevated bilirubin and liver enzymes

102
Q

serious adverse drug effects of acetaminophen

A

hepatotoxicity (in large doses, in therapeutic doses with alcohol), renal toxicity, contraindicated with patients with severe liver disease

103
Q

common adverse drug effects of acetaminophen

A

rash, urticaria, nausea

104
Q

pathogenic prostaglandin

A

inflammation
edema
leukocytosis
release of cytokines

105
Q

physiologic prostaglandin

A

GI
renal
regulates smooth muscle
regulates blood clotting

106
Q

How long do NSAIDs bind to platelets?

A

only for the time the NSAID is in circulation

107
Q

salisilate poisoning (signs, symptoms, treatment)

A

SIGNS:

  • confusion, restlessness, drowsiness
  • sweating
  • thirst
  • hyperventilation

treatment:

  • general tx of s+s
  • gastric lavage
  • IV fluids
108
Q

ASA adverse drug effects

A 
tinnitus
Reye's syndrome
N/V
GI system
Bleeding: epistaxis, ecchymosis, hematuria, hematemosis, hemoptysis, melena, bleeding gums
During pregnancy
ASA sensitive asthma
109
Q

what is the anxiety neurotransmitter?

A

GABA (gamma-aminobutyric aci) which inhibits or slows the excitement of the nerve pathways

110
Q

what benzo is used for pre-op sedation?

A

Midazolam (Versed)

111
Q

3 effects of how Barbiturates, Benzodiazepines and misc. depress the CNS:

A
  1. skeletal muscle relaxation
  2. sedative effect
  3. anti-convulsant
112
Q

adverse drug effects of Barbiturates, Benzodiazepines and misc. - serious and common

A

paradoxical reaction is serious

drowsiness, confusion, ataxia is common

113
Q

contraindications for Barbiturates, Benzodiazepines and misc.

A
  • serious respiratory disorders
  • severe liver and or kidney disease
  • history of allergies or drug abuse with this class
  • potentially addictive
114
Q

4 ways to treat overdose of Barbiturates and Benzodiazepines

A
  1. respiratory support
  2. nasogastric lavage
  3. IV fluids and diuretics
  4. flumazenil (Romazicon)
115
Q

in what circumstances should you hold alpha and beta adrenergic blockers

A

Hold if systolic BP

116
Q

in what circumstances should you hold alpha and beta adrenergic blockers

A

Hold if systolic BP

117
Q

hypokalemia

A

deficiency of potassium in the bloodstream

118
Q

teratogenic

A

Able to disturb the growth and development of an embryo or fetus

119
Q

parenteral route of administration

A

Taken into the body or administered in a manner other than through the digestive tract, as by intravenous or intramuscular injection

120
Q

peristalsis

A

a series of wave-like muscle contractions that moves food to different processing stations in the digestive tract. The process of peristalsis begins in the esophagus when a bolus of food is swallowed

121
Q

ataxia

A

the loss of full control of bodily movements

122
Q

orthopnea

A

shortness of breath (dyspnea) which occurs when lying flat

123
Q

hypervolemia

A

where there is too much fluid in the blood

124
Q

antecubital

A

in front of the elbow; at the bend of the elbow

125
Q

extravasated

A

leakage - when a fluid is let/forced out from the vessel that naturally contains it into the surrounding area

pharmacology (6 decks)

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