Pharmacology Final Exam Review
Nitroglycerine
-Should be refrigerated and kept in a dark bottle without cotton because cotton absorbs the med.
-It needs to be renewed every 3 months Nitrates
-Best for coronary artery disease
-Act on vascular smooth muscle causing it to relax -Cause arterial and venous circulation
-Decrease myocardial oxygen use and increase scleral vessel circulation to the heart -Universal vasodilators
-Used for angina
The heart is fed by the coronary arteries
Vasodilating agents are for peripheral vascular disease -Beta-blockers and calcium channel blockers
Narrowing or constriction of smooth muscle in the coronary arteries and peripheral vascular systems reduces the amount of blood flow to the heart. This lack of blood supply results in diminished oxygen and nutrient flow to the heart causing chest pain or angina and peripheral vascular disease
Peripheral Vascular Dilators
-Relax smooth muscle of the peripheral arteries to increase peripheral circulation -They are used in the treatment of leg pain from vasoconstriction
When using a transdermal Nitro patch, very little if any alcohol consumption is advised. You must also remove the old ointment completely before applying new ointment.
Shaving the chest where you are going to put the patch is not necessary unless there is too much hair then you much shave it
Acute Angina Attack
-Take one Nitro and wait 3-5 minutes and if the pain is still there you take another one and wait 3-5 minutes and the you can take a third, but on the third you must call 911 because you might be having a mild MI
Antidysrhthmics
-An adverse effect is dysrhythmias, which is ironic
Antihyperlipodemics especially with the elderly, disturbed liver function and constipation is a constant threat
The most significant consequence of hyperlipidemia is atherosclerosis
Long term use of antihyperlipidemics the nurse needs to monitor liver function and give the patient vitamins A,D, and K supplements which are taken at bedtime
Cardio Tonics
-Sometimes referred to as cardiac glycosides -They make the heart beat slower and stronger
-2 main actions are to increase the strength of the contraction of the heart and to slow the heart rate
-They very powerful and can be toxic to the heart
-We look for Digitalis toxicity (confusion, nausea, tachycardia, and seeing halos around dark objects)
When a patient is on Digoxin the nurse is looking for anorexia, nausea, vomiting, and weakness along with tachycardia and seeing halos around dark objects
The Therapeutic range for Digoxin is 0.5-2
In the ER when a patient has PVC’s (premature ventricular contractions), it’s a ventricular dysrhythmia. The dug Lidocane is given
Hypertension- a disorder in which the BP is elevated above normal limits for age BP above 140/90 is associated with accelerated vascular damage of the heart, brain and kidneys, which leads to increase risk of death
Primary Hypertension- affects 80%-90% of people with hypertension and the cause is unknown
Secondary Hypertension- when the BP is elevated as a result of another disease process or problem
Diuretics- used to decrease blood pressure by producing sodium and water loss and lowering the rigidity of arteries
Diuretics are used because they are popular, safe, well tolerated, and inexpensive A common adverse reaction to diuretics would be hypokalemia except for potassium sparing diuretics
Lasix- is a loop diuretic and what you would have to do is report weight gain and edema of the feet. The nurse must also check the serum electrolyte levels
Aldactone- is a potassium sparing diuretic
Vasodilators reduce systolic and diastolic BP by direct relaxation of smooth muscle, which lowers vascular resistance
Manoxidil- side effect of abnormal hair growth
Calcium channel blockers should not be suddenly stopped because it can cause very severe rebound angina attacks
Lifestyle Changes to Help Reduce Hypertension Risks
Can be changed: losing weight, increasing physical activity, reduce fat, salt, and calories in the diet, stop smoking, reduce alcohol intake
Cannot be changed: age and race (the black race is more vulnerable) Signs of Dehydration
Dry skin, increased resps, Hypotension, decreased urinary output, poor skin turgor and sunken fontanels in newborns
For urinary incontinence the drug Ditropan is given For BPH the drug Flomax is given
For a UTI then drug Pyridium is given which is a baldder analgesic -Drink 3 liters of water and cranberry combination per day -Report to the Dr headache, rash, vertigo
-Urine turns red orange and stains clothing and toilets
If a patient came in with fever dehydration and diarrhea you would expect that patient to be treated with minerals and electrolytes
3 General Procedures that Underlie all Procedures -Accuracy
-Acceptance of responsibility -Asepsis
Enteral Route- Meds given directly into the GI tract -Oral, NG tube, and rectal
Tablets- dry powdered drugs compressed into small shapes
Capsules- gelatin containers that hold powders or a liquid medication, they cannot be crushed, opened, or chewed
Lozenges- medications that are sucked
If a patient refuses their medication you circle it and document it in the nurses note If the patient has several medications you give the most important one first
Always pour liquids at eye level
NG Tube, G Tube, and Peg Administration- you need to check for placement by injecting 5-10mls of air into the tube and listen for a gurgling sound in the abdominal area
Parenteral Route- ID, IM, SQ, IV
IV it the fastest way to get something into the body ID- 25-27 gauge, 3/8- ½ inch needle, 0.01-0.1ml SQ- 25-27 gauge, ½-1 inch needle, 0.5-2ml Insulin- 25gauge insulin syringe, 5/8 inch needle IM- 20-22 gauge, 1-2 inch needle, 3ml
If you aspirate and blood appears withdraw the needle discard everything and start over When giving a PPD test it’s on a 5-15 degree angle and it should make a bleb or a wheal when you inject the medication
In an infant IM is 1 ml or less, 1 inch needle, in the thigh muscle (vastuslateralis) In an adult IM injection site is the dorsal gluteal muscle is used because it is free of nerves and major blood vessels. The deltoid is used infrequently because its too small and can only accommodate a small amount of medication
If you see an IV that is infiltrated (redness, swelling, and warmth along the vein) stop the IV and call the Dr.. The same goes for if you suspect and allergic reaction during IV administration
Eye Drops
Check the order, wash you hands, clean the eye with normal saline, tell the patient to look up, pull the lower lid down and instill the medication in the lower conjunctival sac, and apply pressure to the inner corner of the eyelid for 1-2 minutes with cotton or tissue Adult Ear Drops
Pull the earlobe up and out. Have the patient lie on the unaffected side, instill the drops, and have them lay there for about 5 minutes
2 Major Neurotransmitters Nor epinephrine and acetylcholine 3 Naturally Occurring Catacolmines
Nor epinephrine- secreted from the nerve terminals Epinephrine- secreted from the adrenal medulla Dopamine- in the brain and GI tract
Diagnosis of a vascular headache is confirmed if it is relieved by 1ml of Ergotamine administered IM
Stopping antimigraine medications abruptly can cause a rebound headache
The action of antimigraine medications it that they block nerve impulses at the receptors of the sympathetic nervous system
Imetrex is an antimigraine agent it can be given intranasally, IM, or PO
Caffeine is sometimes added to the Ergotamine derivatives to speed up absorption orally or rectally
Pregnant women, anyone with a history of depression, or uncontrolled hypertension should not take antimigraine agents
Zeranton causes mood changes, hyper activity, alopecia, and night terrors -Urine turns pink
It takes several weeks before and anticonvulsant can be assessed
Adverse effects of anticonvulsants are course facial features, and excess body hair The drug Seconal has a sedation effect on the brain
Benzodiazepines are diazapine, chlorizepon and chlorizepate
When a patient is on anticonvulsants good oral hygiene is important because of gum hyperplasia
Herbs can be used to treat motion sickness -Peppermint and ginger
Common Symptoms Seen in Parkinson’s Disease
Fine muscle tremors, slow movement, rigidity, muscle weakness, shuffling
The most common antivertigo is Dramamine, which is taken 30-60 minutes before traveling
Zofran is used for nausea and vomiting when chemo is administered -NOT given IV push
-Administered over 20-30 minutes -Given 30 mins before chemo
Antiparkinson’s meds are best tolerated after meals to avoid GI upset Avoid vitamin B6 when taking anitparkinson’s medications
Patient cannot drive while on antiparkinson’s medications
Sweat and saliva darken on exposure to air when taking antiparkinson’s medications Antiemetic Compazine cannot exceed 40mg per day
Thorazine is given for nausea and vomiting and hiccups Do not drive or operate heavy machinery on antivertigo meds Antianxiety meds do not cure they just reduce symptoms
Cheese, sour cream, yogurt, raisins, bananas, avocados, chicken liver, pickled herring, soy sauce, meat tenderizers all contain tyramine and should not be eaten while taking MAO inhibitors
SSRI’s are for long term therapy
Prozac and Selexapro are for minor depressive episodes
Lithium is an anitpsychotic and the patient cannot become dehydrated because it will for toxicity in the body
A blood clot is a thrombus or thrombi
Blood clots that are fixed are thrombi and blood clots that move are emboli
Emboli eventually end up traveling to the heart lungs or brain because that is the normal route of circulation and major damage can occur
Heparin and Coumadin are used as anticoagulants
A low molecular weight of Heparin is called Lovenox and that is used post surgery to prevent clots from forming or present clot from getting larger they do not make clots go away
Coumadin is long term therapy Heparin is short term therapy
-Injected, and spots need to be rotated to prevent Lipodystrophy Heparin antidote is protamine sulfate
-Foods high in Vitamin K are dark green leafy veggies, bananas, onions, fish cabbage veggie oils, cheese eggs liver
When a patient is on anticoagulants you need to look for signs of internal bleeding -black tarry stools, constipation, distended belly
APTT is the lab test to monitor Heparin PT and INR is the lab test for Coumadin
Patients must schedule check ups for PT and INR checks, take the medication on time, avoid vitamin K, report side effects of blood in the urine or stool, unexplained bleeding, take caution in activities that can cause bleeding when taking Coumadin
Effects of Anticoagulants
Bleeding gums, epistaxis, coughing up blood
In an emergency and the patient has a blood clot streptokynase is given to dissolve the clot
Plavix is an anitplatelet agent
Hormones are chemicals that are made in an organ or gland and carried throught the blood stream to another part of the body
Hormones can be natural or synthetic
Hormones can be used to replace or increase natural chemicals in the body Anabolic- builds up or constructs
Catabolic- decreases complexity
Look for hypoglycemia when insulin peaks
Draw up clear then cloudy when combining insulin Oxytocin causes the uterus to contract
Tocolytics are used to stop preterm labor While Taking Steroids
Avoid alcohol
Do not stop taking steroids suddenly No immunizations
Take with food
Adrenal Corticoid agents are widely used for short term treatment to reduce inflammation -Severe poison ivy
Androgens may be used to treat cancer
Some malignant tumors are estrogen dependent Mixedema is the most severe form of hypothyroidism
-Non pitting edema, doughy skin, puffy face large tongue, decreased body hair and dry skin
Synthroid is taken before breakfast and is effective when the patients pulse increases Hyperthyroidism- patient loses weight, increase in metabolic rate
Hypothyroidism- patients gains weight, appetite decreases, dry skin, dry hair, constipation, slow
Opioids- comes from opium, seed of the poppy plant -Morphine and codine
For acute severe pain Morphine Sulfate is given
Talk to the patient about fears of getting addicted to pain meds Pain Scale- numbers, words, colors, faces
Narcan is used for narcotic overdose with resps below 12
No opioids for chronic pain because you have to take the medication all the time Aspirin is the number one anticoagulant and pain reliever
Musculoskeletal relaxants for spasms is Flexeril
-Avoid antihistamines, allergy, or cold meds at the same time -Used for Ms, Cerebral Palsey, arthritis, bursitis
-When used long term they need to be gradually reduced to prevent withdrawal -Not given to children
Greatest common concern is GI distress or GI bleed when taking aspirin
Aspirin is used for mild to moderate pain and it decreases the risk of heart attack and stroke and used for RA
Tylenol is an antipyretic it acts on the heat regulator in the brain Mucamist is the antidote for Tylenol
Tylenol can be toxic especially in children, and an overdose can be fatal, liver toxicity can occur
Need to take NSAID’s with food or milk to avoid GI disturbances
Methotrexate is used for RA, breast cancer, lymphosarcoma, and psoriasis
Penacillimine binds heavy metals like in lead and copper poisoning and only has a 30% benefit
-Cannot be used together with Gold or cytotoxic drugs
Gout is a form of arthritis over production of uric acid forms crystals in the kidneys and they come down and go into the joint spaces and tear and bruise the tissue
-Swelling inflammation and severe pain
Alopurinal is a preventative medication for gout if you tend to get it a lot
Nspaz is atropine sulfate is the most effective of the anticholinergic with minimal side effects when high doses are used
Antacid neutralizes the acidity of gastric contents If taking tetracycline, avoid antacids
6-8weeks for proton pump inhibitors to take effect
Peptic ulcers tend to reoccur, teach the pt to avoid stress, sporadic eating, and infection -May be caused by H.pylori
-Ranitidine is used to treat
Proton pump inhibitor is used for short term treatment of active duodenal ulcers -Take before meals
GERD- Medication is Reglan, which increases gastric motility
IBS- The drug of choice is Benzyl, optimal dosing is take it 30-60 mins before meals and at bedtime
Antacids prevent the absorption of tetracycline
Aluminum magnesium hydroxide gel increased the absorption of Aspirin and Coumadin is absorbed 50% faster when taken at the same time
Adverse reactions in anticholinergic therapy is common because high doses are usually required are, anxiety, dysphasia, dry mouth, urinary retention
No Pepto Bismol if the patient is allergic to Aspirin
If a patient call and reports diarrhea for 3 or more days, do not give them your advise put the Dr. on the phone or take a message and have the Dr. call them back with what they should do
Imodium is a very common antidiarrheal medication
If the patient is on fluid restrictions and is constipated bulk-forming laxatives is not the first choice because they require water to surround the stool
Saline laxatives are used to cleanse the bowel for exams
Stimulant laxatives increase peristalsis by stimulation of the colon nerves (Senna) Check for low potassium, hypokalemia
Bisacodyl must be swallowed whole, never chew, bite, or crush -Never take with milk or antacids
If the patient has been talking a laxative for over a month there is an increased risk for electrolyte imbalance
Dulcolax take with plenty of liquids
An alternative to taking laxatives all the time drink 6-8 glasses of water a day if the diet permits it
Simethicone is and antiflatulent, it breaks up and prevents mucus-surrounded pockets of gas from forming in the intestine
Disulfram (Antabuse) produces a severe sensitivity to alcohol Charcoal is used to absorb poisons
