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
what is donepezil used for and how does it work?
used for Alzheimer disease
Its a cholinesterase inhibitor- it prevents the breakdown of acetylcholine by cholinesterase (so it increases the amount of acetylcholine in the brain)
1. how is h pylori PUD treated?
2. how is NSAID induced PUD treated?
1. at least 2 antibiotics and a PPI and/or H2 antagonist
2. PPI and/or H2 antagonist and misoprostol
What are the treatment options for hyperthyroidism?
antithyroid agents: thioamides (Propylthiouracil (PTU) and methimazole), iodine solutions, and radioactive iodine (131 I)
surgery
Define tolerance and withdrawal syndrome
tolerance- a state in which a particular dose of a drug elicits a smaller response than it did initially
withdrawal- s/s that occur in physically dependent people when they stop using the drug
What is the drug class and MOA of pseudoephedrine
class- a sympathomimetic (means it mimics the SNS)- AKA a decongestant
they decrease overproduction of nasal secretions by causing vasoconstriction
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, what they do, and adverse effects
Prototype: aspirin
What they do: analgesic, antipyretic, anti-inflammatory, and anti-platelet
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, use reliable contraception
What are the drug categories used to treat inflammatory bowel disease (IBD)?
5-aminosalicylic acid (5-ASA) agents
immunosuppressives
corticosterioids
What education should you provide for someone on insulin (in general)
rotate sites
only good for 28 days after you open
do not reuse needles
What are the serious adverse effects of statins?
rhabdomyolysis and severe myopathy
What is the benefit of administering medications as an aerosol? (There are 4)
1. they act directly on the airway
2. they act quickly
3. can usually be given in smaller doses
4. they have less adverse effects
What is the Dietary Supplement Health and Education Act of 1994?
With this act supplements must include a disclaimer that they are not intended to "diagnose, treat, cure, or prevent any disease"
Products must be accurately labeled, but there is no requirement that efficacy be proven before marketing.
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
What is loperamide used for and what is the MOA?
It is an antidiarrheal
MOA- slows motility and movement of water and electrolytes
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 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
Which meds are used for quick relief of asthma?
SABAs and ipratropium
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 does acetaminophen do?
What are max acetaminophen doses for average adult or someone with an alcohol use disorder?
What is the antidote?
1. its an analgesic and antipyretic
2. Average adult = 4gm/24 hours and Alcohol use disorder = 2 gm/24 hours
3. acetylcysteine
What are the adverse effects of centrally acting skeletal muscle relaxants?
dizziness and drowsiness
nausea and constipation
abstinence syndrome
Prostaglandin E analog: prototype, use, and contraindications
prototype: misoprostol
use: prevent or treat PUD caused by chronic NSAID or steroid use
contraindications: pregnancy
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
frequently monitor level of consciousness and other hypoglycemia symptoms
Why is naltrexone used in alcohol use disorder?
It decreases cravings for alcohol and blocks the pleasurable effects
What is the difference between 1st and 2nd generation antihistamines?
1st generation cross the blood brain barrier so they cause drowsiness/dizziness/sedation as well as more anticholinergic effects
calculate how much of the drug will be in your system in 12 hours:
Happy Drug 400 mg
half-life is 3 hours
25mg
1. what are systemic corticosteroids used for?
2. what is important to teach patients taking them?
1. to decrease inflammation
2. do not abruptly discontinue
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
stimulant laxatives: MOA and adverse effects
MOA: stimulates the nerve plexus in the intestines causing increased movement
Adverse effects: diarrhea, abdominal cramping, nausea, dizziness, dependence
1. what is the treatment for hypothyroidism?
2. what teaching would you provide for someone on this medication?
1. levothyroxine
2. take first thing in morning, 30-60 minutes before other pills/food. Take on empty stomach with full glass of water. Monitor for symptoms of hypothyroidism. Need to take this for life and attend lab appointments to monitor TSH levels.
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 is the prototype for leukotriene receptor antagonists and what is the box warning?
zafirlukast
Box warning-neuropsychiatric symptoms (depression, delusions, etc) and suicidal thoughts