Introduction to Pharmacology
What are the 4 phases of pharmacokinetics
absorption
distribution
metabolism
excretion
when do you hold an opioid and when do you administer naloxone?
hold if RR less than 12 and administer naloxone if RR less than 10
Which neurotransmitter(s) is involved in Alzheimers disease?
acetylcholine is decreased
Adverse effects and interactions for antacids
adverse effects: acid rebound, fluid retention and heart failure (sodium bicarb)
interactions: most meds so separate out from other drugs by 2 hours
What are the treatment options for hyperthyroidism?
antithyroid agents: thioamides (Propylthiouracil (PTU) and methimazole), iodine solutions, and radioactive iodine (131 I)
surgery
Name the drug classes used for dyslipidemia
HMG Co-A Reductase Inhibitors (statins)
Bile Acid Sequestrants
Fabric Acid Drugs
Cholesterol Absorption Inhibitors
Niacin
Omega 3 Fatty Acids
When should antihistamines be started for allergies?
before allergen exposure
What is a narrow therapeutic range (index) and what are nursing implications?
Drug has a low safety margin because the therapeutic level is very close to the toxic range. These drugs need to be monitored via labs to look at the random drug level, peak, and/or trough
Salicylates: prototype, contraindications, and adverse effects
Prototype: aspirin
Contraindications: allergy, GI ulcers, bleeding disorders
Adverse Effects:
GI: N/V, dyspepsia, upset, ulcers, bleeding
Bleeding effects
renal impairment
salicilysm
Reyes syndrome
Hydantoins: prototype, therapeutic range, teaching
Prototype: phenytoin
therapeutic range: 10-20 mcg/mL
Teaching: don't abruptly discontinue, obtain routine dental checkups and use soft bristle toothbrushes, don't drive or perform hazardous activities if experiencing CNS depression, notify if you develop a rash
What is the treatment for h pylori?
Needs to be on a minimum of 2 antibiotics and an anti-secretory agent (PPI or H2 antagonist)
Biguanides: Prototype, MOA, and adverse effects
Prototype: metformin
MOA: decreases synthesis of glucose by the liver, decreases absorption of glucose from the intestines, and increases sensitivity of insulin receptors
Adverse effects: GI effects and lactic acidosis
What are the serious adverse effects of statins?
rhabdomyolysis and severe myopathy
Teaching for inhaled corticosteriods
rinse mouth after use to prevent oral yeast infection
needs to be taken daily
dietary supplement regulation: what is actually regulated?
just labeling and manufacturing processes, not safety or efficacy
opioids: adverse effects (common and severe)
common: constipation, sedation, N/V, urinary retention, hypotension, itching, withdrawal
severe: respiratory depression
What is the treatment for status epilepticus?
maintain ventilation
correct hypoglycemia
give IV benzos
Which drug is used as treatment for IBS-C?
lubiprostone
disulfiram: MOA and teaching
MOA: irreversibly inhibits the enzyme that breaks down acetaldehyde so it builds up to toxic levels in the blood and causes potential fatal vomiting and respiratory depression
Teaching: avoid anything with alcohol in it while on the medication and 2 weeks after stopping.
What teaching should be provided for someone on a statin?
1. take this medication at night
2. no grapefruit juice
3. report any muscle or joint pain
4. teach TLC's
MOA of inhaled beta2 agonists and what are they used for?
used for asthma and COPD
They relax bronchial smooth muscle causing bronchodilation
1. main site of drug biotransformation (metabolism)?
2. main site of drug excretion?
3. what are consequences of having impaired liver or kidney function?
1. the liver
2. the kidneys
3. the drugs can build up to a toxic level and they might take longer to be eliminated in the body (so prolonged effects)
what are the schedules in the controlled substance act?
Schedule I - V
schedule I drugs have no accepted medical use
schedule II drugs have the highest potential for abuse and dependence and V has the lowest
What are the adverse effects of centrally acting skeletal muscle relaxants?
dizziness and drowsiness
nausea and constipation
abstinence syndrome
Prostaglandin E analog: prototype, contraindications, and teaching
prototype: misoprostol
contraindications: pregnancy
teaching: need to use a barrier method of contraception
What is the treatment for hypoglycemia?
check blood glucose to confirm
if alert and able to swallow give 15 grams simple sugar and repeat BG check in 15 min
if unable to swallow give glucagon, recheck BG in 15 min, and give food when able to swallow
what are adverse effects of niacin?
flushing and hot flashes (can take ASA 30 minutes before to help), GI effects, and gout
What is varenicline used for and what are the serious adverse effects?
Used for smoking cessation. Serious adverse effects are depression, risk for suicide, and seizures
calculate how much of the drug will be in your system in 12 hours:
Happy Drug 400 mg
half-life is 3 hours
25mg
what are systemic corticosteriods used for?
to decrease inflammation
carbamazepine: contraindications and adverse effects
contraindications: allergy, liver disease, pregnancy
adverse effects:
neuro: CNS depressant
GI effects: NV, elevated liver enzymes, hepatitis
skin: severe reactions
box warning: aplastic anemia and agranulocytosis
lubricant laxatives: MOA and how long to they take to work
MOA: softens the stool without stimulating the GI tract
Takes 24-48 hours to work (usually)
what is the treatment for hypothyroidism?
levothyroxine
What is Michelle's favorite animal to have as a pet?
CATS!!!!
What is the trearment for rhinitis?
take acetaminophen for fever/malaise
use intranasal decongestants- Monitor for symptom relief and rebound congestion
may also use antihistamines or steriod nasal decongestants
1. what are the nursing implications for extended release (ER) drugs?
2. how is the nursin process used for medication administration?
1. they cannot be cut, chewed, or crushed
2. assessment- obtiain thorough history and physical exam
planning- set goals and minimize facotrs that can contribute to med errors
implementation- administer and document the meds
evaluation- assess the therapuetic effects and adverse effects
why is ASA used as an antiplatelet drug but the other NSAIDs are not?
ASA is the only NSAID used to prevent MI/stroke because it is a irreversable platelet inhibitor.
What drug classes are used to treat AD and what are the protypes for each?
1. reversible indirect acting cholinesterase inhibitors (donepezil)
2. NMDA receptor antagonists (memantine)
Medication for IBS-D and the serious adverse effects
alosetron- colitis and death
teaching for levothyroxine
1. take 30-60 minutes before food/beverages (other than water) first thing in the AM
2. teach signs of toxicity (signs of hyperthyroidism)
3. take this every day
4. you need to have periodic TSH testing to make sure the level is therapuetic
How many questions are on the final exam?
100
Contrindications and teaching for inhaled long-acting anticholinergics?
Don’t use if allergic to soybeans, peanuts or soy lecithin.
Need to take it daily