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8/18/2022
Pharmacology 1301 Final Exam Study Guide
1. What are the important questions to ask clients (male) and (female) before starting angiotensin
receptor blockers?
a. Ask if pregnant or lactating (use contraceptives), any history of kidney disease or liver
disease (inc. risk of kidney failure/hepatitis
b. Losartan, valsartan (-sartan): antihypertensives
2. What are the differences between immediate release medications and sustained release
medications? What would you teach the patient regarding administration with each?
a. Immediate release medications (nitroglycerin) work within 5 minutes to relieve
symptoms and there is a limit to how many times you can take it within a certain period
of time (>3x/45) mins; and sustained release meds (calcium channel blockers, beta
blockers) work over a long period of time (5-15hrs) and take effect slower, one must
swallow whole—not crush or split.
3. What are side effects of ACE inhibitors? What are adverse effects of ACE inhibitors? What are
the differences between side effects and adverse effects?
a. Side fx: drowsiness, tachycardia, cough
b. Adverse fx: hyperkalemia, erectile dysfunction, kidney failure
c. Enalapril, ramipril, lisinopril (-pril): blocks vasoconstrictor—thus vasodilating. Resorbs
sodium from kidneys
4. What are first line medications for hypertension?
a. Calcium channel blocker, diuretics, alpha adrenergic blockers
5. What is aliskiren? What additional monitoring needs to be done by a nurse with a client taking
this medication?
a. Antihypertensive/direct renin inhibitor (works like ACE inhibitor), monitor BP close,
pregnancy/contraceptive status
6. What are the 3 classifications of medications for heart failure? What is their purpose in heart
failure? How do they work?
a. Cardiac glycoside
b. Phosphodiesterase inhibitor
c. HCN blocker
7. What is digoxin and describe mechanism of action. What is the therapeutic index? What are
signs and symptoms of digoxin toxicity?
a. It is an antiarrhythmic medication that SLOWS and STRENGTHENS the force of
contractions (decreases conduction) 0.5-2.0 ng/mL. yellow halo, nausea/vomiting
8. Which medication is used to treat atrial fibrillation for long-term?
a. Quinidine, propranolol, digoxin
9. What are some side effects of antiarrhythmic medications?
a. Ortho hypotension, numbness, tremors
10. What is important to teach a client taking anti-arrhythmic medications? What are the different
classes of antiarrhythmics? Are any contraindicated with other medical conditions?
a. Don’t take if recent MI, renal failure.
11. How does nitroglycerin work? How should a nurse teach a client to take nitroglycerin?
a. It vasodilates. Place under tongue. Repeat in 5 mins if no difference for a max of 3 times
in 15 mins. Call 911 if no improvement still.
12. What are calcium channel blockers and their common associated adverse effects? What are
specific disease processes calcium channel blockers are used for?
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a. They block the calcium channels in the heart (vasodilates). Tinnitus, peripjeral edema,
bradycardia, Hypotension, hyperglycemia, gingival hyperplasia. They are for
hypertension, angina, and arrhythmias.
b. Diltiazem/cardizem, verapamil/calan, nifedipine/procardia (ca-)
What are beta blockers? What are side effects? What are important client teaching points?
a. They are meds that block the beta-adrenergic receptors, decreasing the influence of the
sympathetic nervous system. In the heart causing vasolidation, bronchospasm,
hyperglycemia, bradycardia, urinary freq., ED, and memory loss.
b. Metoprolol, Acebutolol, Propanolol (-lol)
List different bile acid sequestrants. How are they administered to clients?
a. Cholestryamine Resin, Colestipol, Colesevelam. Chol-, Coli. Oral administration before meals or before bedtime (AC HS), 1hr before or 46hrs after other drugs (it may bind with them), AVOID GRAPEFRUIT JUICE
What are statin medications (HMG-CoA)? How should a client be advised to take these
medications? What are important considerations to know?
a. Atorvastatin, simvastatin, rosuvastatin, lovastatin. -statin
i. Oral administration at bedtime (can be w/meals), AVOID GRAPEFRUIT JUICE
ii. Notify HCP if muscle pains or tenderness/weakness esp w/fever. Peak fx: 24wks. Use barrier contraception
What is Niacin and what is it used for? List key side effects of this medication.
a. Vitamin B3, used to decrease LDL + triglycerides and increase HDL (stops release of
free fatty acids from adipose)
i. Severe flushing, abdominal cramps, and nausea
What are the antidotes to heparin? Warfarin? What lab values need to be monitored for each?
What drug-to-drug interactions should the nurse be aware of?
a. Heparin antidote: PROTAMINE SULFATE; aPTT; oral anticoagulants, salicylates
(aspirin), penicillin/cephalosporin, nitroglycerin
b. Warfarin antidote: VITAMIN K; INR and PT; alcohol, antiplatelets (aspirin), leafy
greens (vitamin k), most drugs
What is blood thinning/clot busters? How are they given? What are safety precautions?
a. Alteplase, Reteplase, Tenecteplase -ase. Thrombolytics that convert plasminogen (serum
protease that activates to plasmin which dissolves clots) to plasmin.
b. Only given as IV
c. Maintain bed rest and move carefully. Safety precautions
What are some examples of antiplatelet drugs? Why would they be given?
a. Aspirin, Clopidogrel (Plavix), Anagrilide (agrylin).
b. Reduces atherosclerotic events, MI prophylaxis, stroke prophylaxis, ischemic
prophylaxis, intermittent claudication (Cilostazol).
What should a client be taught about taking iron supplements? Adults? Children?
a. The supplements can stain teeth or the injection site; the stool will be dark green; it
should be taken with orange juice (if oral); avoid taking with coffee, tea, milk, whole
grain bread, eggs, antacids, or antibiotics; drink the supplement with a straw; have blood
levels drawn every few months; report constipation to the HCP
b. Children specific: keep out of reach of children, closely monitor administration.
Which medications would treat different types of anemias: Sickle Cell, Pernicious, and Iron
deficiency anemia?
a. Sickle cell: hydroxyurea
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b. Pernicious: cobalamin/vitamin B12
c. Iron-deficiency: iron supplements, ferrous sulfate, iron sucrose/dextrose
Be familiar with each of the following diuretics (Thiazide, Loop, Carbonic anhydrous inhibitors,
potassium sparing, osmotic) and the usual indications that they treat
a. Thiazide diuretics (chlorothiazide, hydrochlorothiazide; -thiazide): edema with HF, renal
dysfunction, cirrhosis, corticosteroid therapy, and estrogen therapy, or management of
HT
b. Loop diuretics (furosemide/Lasix, bumetanide): stronger, faster relief of edema like for
pulmonary edema, HF, hepatic/renal disease, and HT
c. Carbonic anhydrous inhibitors (acetazolamide, methazolamide; -lamide/-amide):
glaucoma, epilepsy, edema
d. Potassium sparing (spironolactone, amiloride/midamor): weaker diuretic for HT, edema
from HF or renal disease, hypokalemia, hyperaldosteronism
e. Osmotic (mannitol): acute increased intracranial pressure or intraocular pressure, acute
renal failure
Which assessment findings and lab findings should be monitored? Are certain diuretics
contraindicated with other medications?
a. Thiazide diuretic labs: liver/renal func., electrolytes (K), I&O, blood glucose, BP, CBC
(for bone marrow suppression);
i. contraindicated with allergy to sulfonamides, do NOT mix with antidiabetic
meds, cholestyramine, digoxin
b. Loop diuretics: electrolytes (K), ABG (for metabolic alkalosis), I&O, blood glucose, BP,
uric acid, CBC (bone marrow suppression);
i. contraindicated with allergy to sulfonamides, do NOT mix with anticoagulants,
salicylates/NSAIDs/ibuprofen
c. Carbonic anhydrous inhibitor labs: ABG (for metabolic acidosis) daily weight/I&O, IOP
(intraocular pressure), BP;
i. contraindicated with allergy to sulfonamides, do NOT mix with salicylates,
lithium
d. Potassium sparing diuretic labs: electrolytes (K), ECG (for arrhythmias), I&O, renal
func./BUN/creatinine
i. Do NOT mix with salicylates
e. Osmotic diuretic labs: I&O, electrolytes, BP;
f. No known drug interactions
What are antihistamines? How are they given? What side effects should a nurse teach a client
about?
a. They block H-1 receptors to suppress an inflammation reaction.
b. They are oral but diphenhydramine (benadryl) can be IM, IV too.
c. Antihistamine side effects: drowsiness, thick secretions
What is acetylcysteine? How is it given? What is it for?
a. It’s both a mucolytic (thins respiratory secretions/breaks apart mucus) and the antidote
for acetaminophen (Tylenol) overdose
b. It can be nebulized, PO, or IV
c. It is used for postop patients, bronchoscope diagnostic, atelectasis, cystic fibrosis, and
tracheostomy patients
What are Xanthines? Who are they given for? What disease processes? Any notable drug-todrug interactions?
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a. Xanthines: theophylline, aminophylline and caffeine; -ophylline. They are
bronchodilators
b. They used to be the mainstay for asthma therapy, but beta agonists and corticosteroids
have replaced them. They are also used in COPD. Prevents and treats bronchospasm
c. They interact with most drugs but it’s very important to avoid caffeine, nicotine
(metabolizes drug much faster) and alcohol.
Understand how each medication helps to treat asthma (Anticholinergics, Sympathomimetics,
Mast Cell stabilizers, leukotriene receptor antagonists, corticosteroids)
a. Sympathomimetics: beta agonists = albuterol, salmeterol, isoproterenol; -ol
i. Stimulates sympathetic nervous system to expand and dilate lungs, also
inotropic/chronotropic (tachycardia + HTN)
ii. Adverse fx: pink discoloration of saliva, hyperglycemia, arrhythmias
iii. Do NOT mix with antidepressants MAOIs
b. Anticholinergics: ipratropium, aclidinium; -ium
i. Chronic COPD/asthma therapy, bronchodilates
ii. Adverse fx: nasal dryness, urinary retention, hypotension
c. Corticosteroids: budesonide, flunisolide, triamcinolone; -ide/-one
i. Decreases inflammatory response in the lungs, maintenance therapy
ii. Adverse fx: hyperglycemia, dry mucosa/fungal infections
d. Leukotriene receptor antagonists: montelukast, zafirlukast, zileuton; -lukast/-leui. Decreases inflammatory response + decreases edema
ii. Adverse fx: drug-induced hepatitis, weakness
iii. Do NOT mix with beta blockers, xanthines, antihistamines, anticoagulants,
CCB’s, antibiotics, or salicylates
e. Mast cell stabilizers: cromolyn (nasalcrom) cromi. Decreases inflammatory response, not used as part of treatment plan since it’s
OTC
What medications are given to treat peptic ulcer disease?
a. H2 receptor antagonists (cimetidine, famotidine, nizatidine) -tidine
b. Proton pump inhibitors (omeprazole, pantoprazole, lansoprazole) -prazole
c. Antacids (aluminum salts, calcium salts, sodium bicarbonate, magnesium salts)
d. Antipeptide/GI mucosal protectant (sucralfate)
e. Prostaglandin (misoprostol/cytotec) -prosHow should a nurse teach a client how to take pancreatic enzyme replacements? Any
precautions?
a. They are oral, taken with food and snacks, do not crush or chew the pill
What are H-2 antagonists? Proton pump inhibitors? How should these medications be given?
Any side effects?
a. H-2 antagonists prevent the secretion of gastric acid. It is given PO AC HS (before meals
+ before bed). Adverse fx: headache, drug-induced hepatitis, arrhythmias, gynecomastia
(cimetidine)
b. Proton pump inhibitors prevent the last step in gastric acid production, decreasing gastric
acid. It should be given on an empty stomach upon waking up, and 1hr before dinner (if
BID). Adverse fx: dizziness, URI symptoms (cough), rash, and bone loss
What are medications to treat constipation? For infants/children? Adults? Elderly? What side
effects should the nurse teach the client about?
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a. Chemical stimulants (biscodyl, castor oil). Adverse fx: cramping, F&E imbal., cathartic
dependence
b. GERIATRIC = Bulk stimulants (psyllium, methylcellulose). Adverse fx: dehydration,
cramping
c. Stool softeners/osmotic laxatives (lactulose, milk of magnesia). Adverse fx: dehydration,
bloating
d. PEDIATRIC = Lubricants (docusate, mineral oil). Adverse fx: leakage, diarrhea
e. GI stimulants (metoclopramide). adverse fx: decreased HR/BP, extrapyramidal fx, fatigue
32. What medications treat diarrhea? What are side effects? What are important client teaching
points?
a. Bismuth subsalicylate (treats travelers diarrhea). Adverse fx: distention, toxic megacolon.
Teaching: stool will become dark, brush teeth with bottled water, avoid aspirin
b. PEDIATRIC = Loperamide (short term antidiarrheal)
33. What medications treat nausea and vomiting? What are side effects? What nursing actions would
be helpful? What off-label uses are some antiemetic drugs also used for?
a. Phenothiazines (prochlorperazine, chlorpromazine) side fx: weakness, tremor, headache.
Nursing actions: mouth care, ice chips, sun exposure protection, fluids, quiet environment
b. 5HT receptor blockers (ondansetron) side fx: urinary retention, constipation, pain at
injection site. Nursing actions: bathroom access, warm compresses
34. What is dornase alfa and what are some important teaching points regarding this medication?
a. Mucolytic (with acetylcysteine) for cystic fibrosis
b. It is nebulized, stored in the fridge, away from light
NOTES
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Antitussives active ingredient causing drowsiness = antihistamine
o Codeine, hydrocodone, dextromethorphan (sugar meth orphan??)
o Dextromethorphan: excessive dose = hallucinations; drug interactions = MAOI
antidepressants
Decongestants = constricts blood flow to nasal area
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Pseudoephedrine (fake ephedrine?) is THE ONLY PO DECONGESTANT, adverse fx:
HT
Diphenhydramine = motion sickness, drowsiness
Saliva substitute (mouthkote, salivart) spray
o For stroke pts and head/neck injury surgery
o Electrolytes thicken saliva
o Do NOT use if: HF, HT, renal failure (abnormal electrolytes), preg./lact.
Pancreatic enzymes (creon, pancrease) PO w/meals or snacks
o For cystic fibrosis, steatorrhea, malabsorption syndrome
o Enzymes help digest/absorb fats, proteins, and carbs
o Do NOT use if preg./lact., pork allergy
o Adverse fx: GI upset, diarrhea, hyperuricosuria
5HT3 agents/antiemetics (-setron) = can be used in children <2yrs
Neurokinin 1 receptor antagonists/antiemetics (aprepitant) = adverse fx: anorexia, dehydration,
constipation, use barrier contraceptives