Study Guide for Pharmacology Exam 1:
Test tips for all Anti-biotics in general:
1. Finish the whole medication – do not stop when the symptoms stop, and do not stop until all
meds are gone
2. Accidental Pregnancies – the 3 C’s
c – Child Care
c – “-cillins” – Penicillin, Amoxicillin
c – “-cyclines” – Doxycycline, Tetracycline
*USE OTHER CONTRACEPTIVES* Oral contraceptives are ineffective
3. No Alcohol – ABX are hard on the liver, no added stress
4. No Food – MTF “Move The Food”
M – Macrolids (Azithromycin)
T – Tetracyclines (Doxycycline)
F – Fluoroquinolones (Levofloxacin)
Take on an empty stomach, increase fluids, and take one FULL glass of water on
administration*
5. No Sun – Avoid “Fun The Sun”
F – Fluoroquinolones – Levofloxacin’s
T – Tetracyclines – Doxycycline’s
S – Sulfa Drugs – SUN Burns
6. No Sun
Sulfonylureas (Glyburide)
Diuretics (thiazide/loops)
Keys Words: Photosensitivity, Avoid “direct Sun exposure”, Wear sun block
7. Super Toxic (Kidneys + Ears)
Vancomycin
Gentamicin
Neomycin
*if too HIGH= KIDNEYS DIE
Must draw a peak and trough
*if too LOW = infections grow
*MUST REPORT* Vertigo, tinnitus, Creatine over 1.3, BUN over 20, urine output less than 30*
Sulfonamides:
Fluoroquinolones: (Quinolones):
Ex. Trimethoprim, Sulfamethoxazole (Bactrim)
Ex. Levofloxacin (Levaquin), Ciprofloxacin,
Norfloxacin
MOA: Stops bacteria folic acid synthesis
(Bacteriostatic)
Indications: Frequently used for UTI’s
Contraindications: Renal Disease, Pregnant
women, and young children
Adverse Effects: Steven Johnson Syndrome,
Photosensitivity, Kidney Stone Development
Memory Trick:
S: Sun Burn (Sunblock & Avoid the sun)
U: Urine (Crystals & Specific Gravity) (High and
Drive)
L: Lots of fluids (Water, 2 – 3L a day)
F: Folic Acid (take this daily)
Contraindications:
-
Allergies
Glyburide (oral diabetic drug)
Indications: Pneumonias & UTI (bactericidal)
Contraindications: Children <18, Hx of
tendonitis
Memory Trick:
-Floxacin = Fall – xacin,
-floxacin= flex-acin
Adverse Effects: GI upset, Tendon Rupture,
Report Thrush
Key points:
-
Avoid sun “direct sun exposure”
Achilles tendons RUPTURES
Report any and all muscle pain
Contraindications: Tendonitis
Not the same as a -MYCIN drug
1 hour BEFORE or AFTER meal
Key Points:
Not Pregnant safe, Increase Fluids, urine specific
low, N/V/D
Penicillin’s:
Cephalosporins:
Ex. Cephalexin (Keflex), Cefazolin, Ceftriaxone
(Rocephin) -Cillin endings
Ex. Cephalexin (Keflex), Cefazolin, Ceftriaxone
(Rocephin)
Indications for use: Broad spectrum,
pregnancy and breast feeding safe
Interactions: Alcohol, Antacids, Iron: Decreased
absorption of ABX, take all separately
Interactions: Methotrexate – increased
electrolyte levels d/t decreased elimination
Birth controls pills
Warfarin – enhanced anticoagulation effects
Will inactivate aminoglycoside
Side Affects: GI Upset, Avoid use w/ patients
who have hx of bleeding disorder or
anticoagulant,
Side Affects: N/V/D, Steven Johnson
Syndrome, hives renal impairment,
hypernatremia, hyperkalemia, superinfection,
low platelets
Nursing Implications: Take with water,
Increased bleeding risk, use secondary birth
control, take full dose
Memory Trick: 3 C’s – Cross sensitivity,
Ceph/Cef, Cillin
During a Reaction: Stop, assess, epi
-
Diarrhea or other reaction: STOP DRUG
Nursing Implications: Assess for allergy to
Penicillin’s, give with food if stomach is upset,
NO ALCOHOL up to 72 hours (Cefazolin and
Cefotetan)
Key points: Question the provider if they order
a cephalosporin and they patient is allergic to
penicillin’s, or other way around
Macrolides:
Tetracyclines:
“-Thromycin” endings
Ex. Tetracyclines, Doxycycline
Ex. Azythromycin, Erythromycin
Indications: Treatment of Rikettsia, Chlamydia,
Lyme Disease, Syphilis, PID, Acne
Indications: Broad Spectrum, URI/LRI, Lyme
Disease, STI’s, Chlamydia, Mycoplasma,
Pneumonia, Strep. Infections
Interactions: Inhibits metabolism of digoxin =
toxicity, monitor the levels, should not be taken
clarithromycin & erythromycin = prolonged QT =
malignant dysrhythmias
Adverse Side Effects: Prolonged QT = could be
cardiac arrest, Hepatotoxicity = monitor AST,
ALT
Nursing Implications: No Juice, only water,
make sure that they have baseline cardiac and
liver function tests, MONITOR EKG
-
Don’t give Tylenol = affects the liver
double time
Memory Tricks: Thromycin = throws ECG
waves = “prolonged QT intervals”
Interactions/Adverse Side Effects: Tooth
Discoloration, superinfection (C. Diff), GI Upset,
Photosensitivity, Hepatotoxicity
Nursing Implications: Use second form of Birth
control, take on empty stomach, MUST STI UP
AFTER 30 MINS OF ADMINISTRATION – do not
take dairy products, antacids, iron
Memory Tricks: Cycling is dangerous – Not safe
for a pregnant mother, BUGs in their teeth =
discoloration, use sun block while on the cycling
trip
Key Points:
-
NOT pregnancy safe
MUST USE OTHER BIRTH CONTORL
Tooth Discoloration
Sun Burns – Wear Sun
Common Side Effects: N/V/D. Fever,
Decreasing WBC = infection is working
Aminoglycosides:
Vancomycin:
“-Mycin”
Indications: Given for a serious infection like
MRSA and C. Diff
Ex. Gentamycin, Tobramycin, Neomycin
Indications: Often used with other antibiotics,
given parenterally, Cystic Fibrosis
Interactions: Increased Nephrotoxicity, with
other nephrotoxic drug, Increased ototoxicity
with loop diuretics
Side Effects: Nephrotoxicity (reversible),
Ototoxicity (irreversible), tinnitus, feeling of
fullness in ears, headache, skin rash
Nursing Implications: Encourage Fluids, (>
3L/day unless contraindications), Assessment of
baseline hearing and renal test, IMMEDIATELY
REPORT S/S OF OTOTOXICITY,
NEPHROTOXICITY = stop the drug
-
Draw serum levels 15 – 30 mins before
next does
Never mix with Penicillin’s/ Vancomycin
Monitor the BUN and Creatinine
Interactions: Renal Dysfunction, hearing loss,
elderly & neonates
-
ETOH, Benzos, Ca Channel Blockers,
Cyclosporine
Side Effects: Rapid infusions can cause:
Hypotension, Red Man’s Syndrome, ototoxicity,
nephrotoxicity
Nursing Implications: Adequate Hydration (2
L/24 hrs) = prevents nephrotoxicity, burns
during admission, can cause thrombophlebitis –
monitor IV site closely, may extravasate
Key Points: Check 15 -30 mins before “next
dose” or “administration”
-
Report and hold over 20 = vancomycin
If the patient is having anaphylaxis
o STOP, EPI
RED MAN SYNDROME IS NOT
ANAPHYLAXIS
Metronidazole:
Ex. Flagyl
Indication: Anaerobic organism, GYN infections,
P.O. to treat C. Diff, STI
Interactions: ETOH, Lithium, Benzo,
Cyclosporin, Ca+ Channel Blocker, Phenytoin,
Phenobarbital (Seizures meds)
Adverse Effects: Headache, Dizziness, NVD,
Thrombocytopenia
Nursing Implications: Baseline CNS, GI, GU,
and ETOH Assessments
Contraindications: Allergy, 1st trimester,
caution in renal/cardiac/seizure disorders
Key Points: Avoid ETOH during and 3 days
after treatment, if patients do have ETOH = will
have violent vomiting & cramping
Normal Side Affects:
-
Dark Urine “Discoloration”, metallic
tasting
Deadly Side Affect:
-
Report any new rash or skin peeling
Report Steven’s Johnson Syndrome
Memory Trick:
M – Metallic tasting (normal)
E – ETOH AVOID
T – Treats C .Diff & STI (Trichomoniasis)
R – Rash or Skin Peeling
O – Oh Not Dazzling (“Dazole”ing)
Immunosuppressants:
(Selectively Suppresses T Lymphocytes)
Azathioprine (Imuran)/ Cyclosporine
(Sandimmune):
Methotrexate:
MOA: Blocks cell regrowth, and proliferation
MOA: Stops folic acid metabolism which stops
cell reproduction
Indications: To prevent Organ Transplant
Rejection
Indications: Rheumatoid Arthritis (Body
attacking its own joints)
Precaution:
Before giving this med:
Adverse Effects: Low Immunity = Infections,
Low Platelets = Serious Bleeding, Fetal Death
while pregnant
Nursing Implications:
-
No pregnancy
No crowds or LIVE vaccines
No Razors or brushing teeth hard
Key Points:
-
-
Infection Risk
o Avoid Crowds
o Avoid Fresh Fruit and Flowers
Thrombocytopenia (Platelets under
100,000)
Men … no trying for a baby until 3
months after treatment is complete
-
Check WBC & Platelet
Report Leukopenia (<4000)
Monitor for bleeding (Thrombocytopenia)
No babies (use other contraceptives)
Common Side Effects: Cyclosporine, Gingival
Hyperplasia
Nursing Implications:
-
Avoid Crowds
No Live Vaccines (Herpes + Shingles)
Soft Bristles toothbrush
Use contraceptives
Immunomodulators:
Monoclonal Antibodies: Varied throughout the types of antibodies (ends in -mab’s)
Adverse Effects: Hypersensitivity, Flu like symptoms – Flu like, Capillary Leak syndrome = low BP,
Black Box Warning: Serious infection, lymphoma, malignancy, allergic reaction is common
-
Uncommon: Hepatotoxicity, Bone Marrow Suppression, CNS effects
Nursing Implications: Pre-medicate with Benadryl, and Antihistamine
Ex. Adalimumab
- Acts on the TNF [Tumor Necrosis Factor]
(Crohn’s, RA, and Psoriasis)
Ex. Certolizumab (Crohn’s, RA)
- TNF antagonist
Ex. Infliximab
- Acts on the TNF (Crohn’s, RA, and
Psoriasis, Ulcerative Colitis)
- Contraindicated: Heart Failure
- Black Box Warning: Fatal = TB, Fungal
Interactions
Ex. Natalizumab
- Blocks proteins on WBC (MS)
Ex. Rituximab
- Binds to B cells and causes lysis
- MUST PREMEDICATE w/ Benadryl, and
antihistamine
Monoclonal Antibodies:
Nursing Implications:
-
Assess for cautions (infections), and other contraindications first
Assess for hypersensitivity
o See if it is necessary to pre-medicate first
TB Test first
INFECTION IS KEY
Systemic Lupus:
Chronic Multisystem inflammatory autoimmune disease
Affects: Skin, Joins, Serous Membranes (Pleural spaces around the lungs, and the heart), Renal System,
Hematologic system, Neurologic system
Etiology: UV Light, Stress, Chemicals, Toxins, Infections
Pathophysiology: Autoimmune reaction – autoantibodies attack nucleic acids, erythrocytes, coagulation
proteins lymphocytes, platelets, & other cells (Type III hypersensitivity reaction)
Treatment:
NSAIDS = arthritis
Antimalarial Agents:
Hydroxychloroquine (Plaquenil)
Used to treat fatigue, skin and joint complications
May take months to see (+) effects
May prevent flares
Side effects: Retinopathy and visual changes (Blurry, Vision changes)
Must have eye exams Q6 months
Immunosuppressants:
Methotrexate (meth-no-trexate)
Prescribed in combination with folic acid to help decrease the side effects of corticosteroid
therapy
Side Effects: Infection
Azathioprine (Imuran)
Cyclophosphamide (Cytoxan)
Belimumab
Monoclonal antibodies – work on the B lymphocytes
Must premedicate with reaction
Contraindications: Cannot use if: Breastfeeding, severe renal disease, CNS manifestations
of SLE, depression, active infection (like TB infection) (No live vaccines)
Active vs. Passive Immunity:
Active:
Passive:
Definition: Exposure of the body to the associate
disease antigen
Definition: The host is given the ability to fight
off an invading microorganism
Type of: Toxoid or vaccine
Type of: Immunoglobulin or Antitoxin
Artificial: Exposure to the vaccine
Artificial: Person is inoculated with serum
containing immunoglobulins obtained from
other humans or animals- antibodies already
prepared for the host, the host doesn’t always
have to make them
Ex. Flu, Herpes Zoster, Chickenpox,
rubella
Natural: Immunity by surviving the disease
Ex. Hep B, Rabies, tetanus, Varicella,
Antivenin
Natural: Mom to baby via breast milk, or
bloodstream via placenta
First line of defense – Innate immunity (Physical, mechanical, biomechanical barriers)
Second line of defense – Inflammation (Mast cells continuously searching – which if they find something
they then release an antihistamine or WBC to the site)
Third line of defense – Adaptive (acquired) (Specific) immunity
HIV:
Hard virus to kill due to the virus living within the cell itself
Key Characteristics of antiviral drugs:
-
Able to enter the cells infected with virus
Some drugs stimulate the body’s immune system
Antiviral drugs are in patients with competent immune systems
A health immune system works synergistically with the drug to eliminate or suppress viral
activity
Best Medications never fully eradicate the virus:
-
Host immune system has a better chance of controlling or eliminating when virus cannot
replicate
Pathophysiology of HIV:
1. Virus bends to specific CD4 receptors to enter the T-cell (Fusion)
2. Reverse transcriptase (which is the enzyme that is brought along with the HIV virus) assists to
make viral DNA from RNA
a. Viral DNA enters host cell nucleus and splices itself into genome permanently (Integrase)
b. Protease, puts “pieces together” for the final viral cell
3. Consequences of integration into genetic structure
a. All daughter cells are infected, viral DNA will direct cell to make HIV
Antiretroviral Drugs:
Fusion Inhibitors
-
Inhibit viral fusion, preventing viral replication
o Ex. Enfuvirtide (Fuzeon)
 MOA: Supress the fusion process
 Contraindication: Severe Allergy or intolerable toxicity
 Form: Injectables
Entry Inhibitor – CCR5
-
Block entry into the cell
o Ex. Maracviroc (Selzentry)
 MOA: Block entry into cell wall
 Contraindications: Severe Drug allergy
 ADE: Hepatotoxicity (Assess LFT’s)
 Form: PO only
Reverse Transcriptase inhibitors (RTI’s)
-
-
Blocks activity of the enzyme reverse transcriptase, preventing production of new viral DNA
Nucleoside reverse transcriptase inhibitors (NRTI’s)
o Ex. Zidovudine (Retrovir) (Azidothymidine) *FIRST LINE OF TREATMENT*
 MOA: Block the enzyme
 ADE: Bone Marrow Suppression (high risk for infection) (May need to switch the
drug)
 Patient Education: given during pregnancy to prevent transmission to fetus/infants
 MUST SIT UPRIGHT AFTER 30 MINS AFTER TAKING THE MEDICATION
o Ex. Tenofovir (Viread)
 MOA: Block the enzyme (Reverse transcriptase)
 Contraindications: Liver dx, Bone marrow suppression (Decrease RBC, Decrease
WBC, Decrease Platelets)
 ADE: Lactic acidosis, hepatomegaly
 Form: Oral
Nonnucleoside Reverse Transcriptase Inhibitors (NNRTI’s)
o Ex. Nevirapine (Viramune)
 MOA: Inhibit the action of reverse transcriptase
 ADE: Rash, Fever, Nausea, Headache, LFT Elevation (Hepatoxicity)
 Patient Education: Use with NRTI’s
 Form: PO
Protease Inhibitors (PI’s)
-
Inhibit the protease retroviral enzyme, preventing viral replication
o Ex. Indinavir (Cixivan) & Ritonavir (Norvir)
 MOA: Inhibits protease enzyme, which prevents viral replication
 Contraindications: Pancreatitis, Liver Dx, diabetes
 Adverse Desired Effects: Nephrolithiasis (Drinks lots of fluids), N/V/D,
Lipodystrophy (Insulin Resistance)
 Form: PO, EMPTY STOMACH
 Patient Education: Use other forms of contraception’s
HIV integrase strand transfer inhibitors (Integrase inhibitors)
-
Blocks the function of integrase
o Ex. Raltegravir (Isentress)




MOA: Bind with integrase enzyme and prevent HIV from incorporating its genetic
material into the host
Contraindications: Severe Allergy and intolerable toxicity
ADE: Muscle myopathy, rhabdo
Form: PO
Nursing Implications for all HAART Drugs:
-
Patients will require lifelong therapy
o If the patient develops resistance -> change the combo of drugs up
All drugs must be given at evenly spaced intervals, Around the clock to ensure a steady state
Asses for contraindications, conditions that may indicate cautious use, and potential drug
interactions
THESE DRUGS ARE NOT CURES; THEY ARE ONLY TO HELP MANAGE SYMPTOMS
Cancer:
Malfunction of genes that control growth/differentiation
Stages:
Initiation – DNA mess up w/ radicals, Chemicals, sun, Tabaco products

Tumor must reach a critical mass that can be detected (1 cm on palpation, 0.5 cm
by radiologic test)
Promotion – Proliferation w/ growth of cells, and substation of apoptosis (programmable cell
death)


Reversible proliferation of altered cells, and this gets promoted by: Dietary fats,
obesity, tobacco, ETOH
This means they person needs lifestyle medications
Progression – Cancer cells are good with angiogenesis (creating their own vascular system/ blood
supply)

Increase in growth rate & invasiveness, metastasis
 Tumor develops its own blood supply
 Cells detach from the tumor and invade surrounding tissues
 Penetrate lymph & blood vessels = metastasis
o Common Areas:
 Liver
 Bone
 Brain
 Lung
 Adrenal Glands
TNM Classification of Cancer:
Chemotherapy Treatment:
-
Chemotherapy is a combination of multiple drugs
The most affected drugs are those that are rapidly dividing cells
o Hair Follicles
o Lining of the GI tract
o Bone Marrow
Contraindications
-
Very rare to have absolute contraindications
Premedication is relevant for people with allergies
Low WBC (Infections)
Severe nutritional compromises & dehydration
Impaired renal, hepatic, or other major organ functions
Having a high neutrophil count (<500 cells)
o No fresh flowers, fruits, crowds
Caring for patients that have chemo drugs in their system:
-
Double flushing of bodily fluids in the commode
Special hampers for disposal of all objects that encounter patients’ bodily fluids
Personal Protective equipment
Special procedure if liquid spills
Common ADE:
-
Women need to use other forms of contraception’s that are not drugs
Erythema/hyperpigmentation
Alopecia
Monitor weight loss
SMALL, FREQUENT, HIGH PROTEIN, HIGH CALORIC MEALS
N/V/D (Puts the patient in metabolic alkalosis) (give the patient an antiemetic)
BONE MARROW SUPRESSION
o Anemia
o Leukopenia
o Thrombocytopenia
o NADIR (first 7 – 10 days after initiation of treatment, the patient is most
immunosuppressant
EXTRAVASATION:
If suspected: Stop the infusion immediately, but do not remove the IV, some IV antidotes will be given in
that same space that the catheter was in
Cell Cycle Specific Drugs:
Methotrexate (Antidote – Leucovorin)
MOA: inhibit cell growth through interfering with folic acid synthesis
Contraindications: NO PREGNANCY
ADE: Sever Bone Marrow Suppression
Cell Cycle Non-Specific Drugs:
Cyclophosphamide (Cytoxan) – Bone Marrow Suppression, increased risk of bleeding (monitor Urine
output), and H&H [hemorrhagic cystitis]
Cisplatin (Platinol) = Renal Toxicity (monitor kidney damage, Creatine <1.3, BUN <20, Urine output >30),
ototoxicity (vertigo, balance problems)
ADE: Alopecia, GI effects, BMS, Extravasation