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Pharmacology Study Guide: Drugs, Actions, and Effects
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Final exam study Guide- 75 questions 1. Understand Pharmacodynamics How the living organism reacts with the drug or the chemical Chemical components of living system and the drug- how it affects body Way drug effects the body, body reacts with drug 2. What are the effects of Dobutamine Treatment of heart failure -heart rate increases with increased myocardial contractility -bronchi dilate -respirations increase in rate and depth -blood vessels constrict causing an increase in blood pressure -intraocular pressure decreases -glycogenolysis (breakdown of glucose stores so that the glucose can be used as energy) -pupils dilate -sweating can increase Acts on both receptor sites but has a slight preference for beta 1 receptor sites. It is used for treatment of heart failure because it can increase myocardial contractility without much change in rate and does not increase oxygen demand of the cardiac muscle Increases heart rate, bronchodilation, is both (beta 1 preference ) does not increase cardiac demand on muscles 3. Understand the actions and use of Dopamine Nonselective-- Affects both alpha and beta receptor sites (adrenergic agent). Used for shock or cardiac arrest. Nonselective, increases BP, dilates arteries, by release of norepinephrine 4. patient teaching of clonidine (catapres) Stimulates alpha 2 receptors and is used to treat hypertension because its action blocks the release of norepinephrine from nerve axons Tapered over 2 to 4 days because adrenergic receptors will be sensitive and rebound hypertension, tachycardia, arrhythmias, and even death can occur Alpha specific adrenergic agonists, must wean off of it for risk of rebound hypertension, ALPHA 2, used for opiate withdrawal and chronic pain 5. The adverse effects and cautions of alpha-specific adrenergic agonists (chapter 29) Drowsiness- caution with operating heavy machinery, do not mix with alcohol or antihistamines Alpha specific agent, can cause hypertension, pirate withdrawal, chronic pain. Takes hour and a half to kick in, do not discontinue suddenly, have to taper the drug over 2-4 days. Must taper drug 2-4 days Get anxiety, restlessness, fatigue, sensitive to light Heart effects- EKG changes, arrhythmia changes, BO changes 6. The indications and actions of labetalol Non selective adrenergic blocking agents Treatment of hypertension (alone or in combination with other drugs), hypertension associated with pheochromocytoma, clonidine withdrawal Competitively blocks alpha and beta receptor sites in the SNS leading to lower blood pressure without reflex tachycardia and decreased renin levels Adrenergic Antagonists, safe for preggers ( also bile acid sequestrants ) Used for hypertension, for stroke patients, claudine withdrawal, blocks norepinephrine Adverse effects- orthostatic hypotension 7. Cautions and adverse effect of Nonselective alpha-adrenergic blocking agents Asthma, COPD, emphysema should not be used because of bronchoconstriction on looses norepinephrine effect norepinephrine effects loss issues with bronchodilation Adverse effects- respiratory issues (cough), hypotension, GI upset, cardiac arrhythmia, edema 8. The therapeutic actions of metoprolol (Lopressor) Used for patients with asthma, copd, emphysema Decrease intraocular pressure in glaucoma patients Beta1 selective adrenergic blocking agent Treatment of hypertension, prevention of reinfarction after MI, early acute MI treatment, treatment of stable and symptomatic heart failure (extended release only) DO NOT PREVENT SYMPATHETIC BRONCHODILATION Beta 1 selective adrenergic blocking agent, treats hypertensions, angina, cardiac arrhythmias. Work by selectively blocks receptors in heart Decrease hr, lower excitement, decrease arrhythmias, decreases oxygen consumption Better for those with respiratory conditions. 9. agents used for Mysthenia Gravis- (indirect -Acting Cholinergic Agents) therapeutic actions Cause disruption of Ach receptors so fewer receptor sites, muscle weakness etc. (pyridostigmine) increases levels of Ach helps transmission of neuromuscular junction, Adverse effects- urinary infrequency, bradycardia, incontinence, nausea/vomiting, cardiac arrest Erdophomium is used for diagnosis and reverse toxicity, pyridostigmine is to help maintain it. Increases levels of Ach. Helps with muscle weakness Bradycardia, incontinence, nausea 10. Agents used for Alzheimer Disease. know the adverse effects Donepezil Slow progressing, memory loss, disorientation, can lose body functions, plaques on brain Insomnia, fatigue, nausea, vomiting, muscle cramping 11. The use and adverse effects of atropine bradycardia cardiac is biggest one (shock treatment), antidote for cholinergic drugs, before surgery to dry up secretions Blurred vision, palpitations, tachycardia, photophobia Anti-cholinergic agent/parasympatholytic Decrease secretions before surgery, Bradycharidia is biggest one To much atropine can be for cholinergic drugs ( neostigmine ) 12. Hypertension first line therapy for African Americans Calcium channel blockers (cartiazem) and diuretics 13. Angiotensin II receptor Blockers (ARBs) Losartan adverse effects -sartan Used for hypertension, alone or combo, diabetes hypertension, those with elevated creatinine or proteinuria-- kidney saving Patient comes in starting to feel like they are getting a cold/sick-- this is an adverse effect -dizziness, headache, diarrhea, abdominal pain, symptoms of upper respiratory tract infection, cough, back pain, fever, muscle weakness, hypotension RAAS 14. The actions of ACE inhibitors (pril’s) Slight increase in serum potassium so sodium will decrease and so will water Prevent angiotensin 1 to converting to 2 Lowers BP and aldosterone Can have angioedemaa in African Americans 15. Vasodilators cautions and adverse effects Do not take with NSAIDS or blood thinners Work to cause smooth muscles to relax so blood vessels with dilate leading to decrease in blood pressure Dizziness, cyanide toxicity (dyspnea, vomiting, ataxia, loss of consciousness) reflex tachycardia, chest pain, edema, rash, lesions nausea, vomiting, diarrhea 16. The therapeutic actions of droxidopa Used for orthostatic hypotension Hypertension is the biggest adverse effect 17. The use, cations and adverse effects of digoxin Used for Afib when calcium channel blocker cannot be used- does not lower blood pressure. Dig toxicity is big caution- seeing halos is a sign, headache, weakness, drowsiness, vision changes, get a dig level (blood work) and see therapeutic range 18. Nursing consideration when Pt are taking phosphodiesterase Used for short term heart failure for those not responding to vasodilators or diuretics milrinone Arrhythmias, hypertension, thrombocytopenia Always check blood pressure and heart rate, get a cdc to make sure within normal limits, EKG 19. Ivabradine actions and cautions Patients dependent on pacemaker- extreme bradycardia can happen bc it blocks that receptor 20. The different classes of antiarrhythmic drugs their therapeutic actions Class 1- lidocaine used for PVC, during surgery, MI Class 2- Propranolol- hypertension, angina, migraines, SVT need to worry about hypotension, bradycardia, arrhythmias, crazy dreams, bronchospasms Class 3- amiodarone- used in cardiac arrest or shock, life threatening Class 4- cardizem diltiazem, used for afib and SVT, Aflutter 21. Drugs used for angina- nitrates, beta blockers, calcium channel blockers. (nitroglycerin, metoprolol, and diltiazem) actions and adverse effects 3 types of angina Stable- when you rest it feels better Unstable- random Prinzmental- spasm of artery Nitroglycerin- 3 tablets every 15 minutes, still have chest pain have to go to hospital Metaprolol- if someone is starting this tell them to take breaks and space out their activities (exercise intolerance) 22. Bile acid sequestrants- pharmacokinetics Lipid lowering, acts in intestines and are excreted directly into feces 23. HMG-CoA reducatase inhibitors- adverse effects -Statin Work by inhibiting enzyme, reduce LDL and triglyceride levels Rhabdomyolysis- coca cola urine, muscle weakness and pain-- muscles breakdown and waste products enter glomerulus can get headache dizziness blurred vision fatigue 24. The antiplatelet drug- clopidogrel (Plavix)- actions and indications Helps reduce from getting ischemic attacks and MI, plaque in arteries clogging it, these thin that to decrease aggregation of platelets, reduce risk from developing thrombus 25. Nursing considerations for Pt receiving anticoagulants Bleed easily, do not combine with NSAIDS, check stool for blood (dark, tarry bright red), caution in contact sports, be careful when shaving--electric razor more suitable 26. Pharmacokinetics of epoetin alfa Treatment of anemia associated with cancer chemotherapy, metabolized in serum same way erythropoietin is. 27. Ferrous sulfate- adverse effects CONSTIPATION Used for iron deficient anemia 28. Agents used for sickle cell anemia- hydroxyurea Used during painful crisis and individuals needing blood transfusion 29. The difference between mucolytics and expectorants Tussin- stimulate medulla so you do not cough (suppress cough reflex) Codeine works that way too Mucolytics help you produce a productive cough when you have a non-productive cough (aid in clearing of airway) Expectorants help you cough up the secretions that come with a productive cough (liquefy lower respiratory tract reducing viscosity of secretions) 30. The use of long acting beta agonists (LABAs) Should never be used alot, use with inhaled corticosteroid 31. Risk factors when taking OC CV and thrombotic events- stop smoking 32. Indications for Clomiphene Treatment of infertility Treatment for patients with normal liver function and normal estrogen levels- but ovaries failure Adverse effects- increase risk for multiple birth and birth defect Breast tenderness, ovarian enlargement 33. Anabolic steroids- oxandrolone actions and adverse effects Change mood, lability, more aggressive, angry Affects liver- jaundice is a sign, icteris 34. Risk factors with NSAIDS Not mixed with hypertension meds, check stool for blood Increased risk of GI bleeds, increased risk of cardiovascular events (cox-2 inhibitors) 35. The pharmacokinetics’ of interleukins Communicate between lymphocyte to increase cellular immunity suppress tumor growth Adverse effect- used to stimulate immune response Used for metastatic renal carcinoma- kidney cancer that spreads to other parts of the body Cancer patients are immunocompromised-- more at risk for any other illness, Bone marrow suppression, respiratory illness, fever, chills, risk for infection 36. T- B cell suppressors – cyclosporine Used for organ rejection in anyone whos had a transplant Adverse effect- at risk for infection, bone marrow suppression- if get a fever need to come in and be seen 37. Therapeutic action and pharmacokinetics of carbapenems Antibiotics, bactericidal and inhibit cell membrane synthesis Adverse effects- cdif, diarrhea Anvanse- used for treatment of pneumonia, GU, intra abdominal infections Vomiting, diarrhea, always do probiotics 38. Patient teaching with cephalosporins 1st, 2nd, 3rd, 4th generation Avoid driving, avoid alcohol, drink alot of fluid, HAVE TO FINISH ENTIRE REGIMEN 39. Drug-drug interactions with fluoroquinolones Great for UTI control, GI, joint infections, eye drops (infections) for contact wearers Do not use in children ever, avoid in elderly Can cause tendon rupture if used with corticosteroids and fatal cardiac reactions 40. Pt and family teaching about penicillin’s box 9.6 Take full course, drink lots of fluids, look for infections of mouth and vagina Do not take with fruit juice, soft drinks, milk 41. Cautions and contraindications with sulfonamides Bactrim Should not be used with diuretics, cannot use in pregnant especially those lactating and can cause serious diarrhea, rash issues, 42. Nursing considerations with tetracyclines Avoid the sun, lots of fluids, administer on empty stomach, take full course 43. Adverse effects with lincosamides Clindamycin Topical and oral for acne, can be used for dental infections, if pen allergic CDif- severe gi reactions 44. Pt teaching about Tamiflu- when to start the meds and how does it work Start the drug as soon as possible after the exposure of the virus (within 2 days) of the start of symptoms to enhance effectiveness and decrease the risk of complications due to viral infection Administer full course to obtain full beneficial effects Agents prevent shedding of viral protein coat and entry of virus into the cell- prevents viral replication causing viral death. Only antiviral agent shown to be effective in treating H1N1 and avian flu Shortens duration by 1-2 days 45. Acyclovir treatment use and adverse effects Used for herpes and CMV, herpes zoster, genital herpes, HSV 1- la HSV-2 = genital All hepatic in nature Also used for bell's palsy Can come in oral, IV, topical, eyedrops Headaches, vertigo, nausea, vomiting rash 46. Fixed combination drugs for treatment of HIV infection Have these for compliance Give to those infected with HIV and prophalacticly- needlestick, unprotected sex, pretention 47. Treatment uses and actions of clotrimazole -zole= anti fungal Yeast infections, all types of tinea, binds to sterol in fungal cell membrane changing permeability and allowing leakage of components 48. Nursing considerations with Pt taking antimalarial agents Monitor for liver damage and eye Want to obtain liver function test and blood culture 49. Use and adverse effects of metronidazole Used for GI, trichomoniasis, last resort if clindo does not work Tell patient to avoid alcohol or they can get violently ill (extreme nausea, diarrhea, vomiting) 50. Pt teaching about mebendazole Used for worms, take full course, want stool cultures, always report any fever diarrhea any change in condition 51. Adverse effects of methotrexate Used for leukemia, lymphoma, rheumatoid arthritis, osteocarcinoma, diff types of cancers Bone marrow suppression, anemia, liver issues, fatigue, malaise, risk for infection, 52. Therapeutic actions and indications of H2 antagonists Used for gerd and ulcers by blocking h2 antagonists Zantac Can cause cardiac arrhythmia, GI sensitivity, 53. Adverse effects of antacids Neutralize stomach acid Milk of magnesia Can have acid rebound, weakness, hypokalemia, confusion, 54. How do bulk stimulants work? Laxatives that cause the fecal matter to increase in bulk. They increase the motility of the GI tract by increasing the size of fecal matter, which helps to pull more fluid in the intestinal contents. This will stimulate local stretch receptors and activate local activity. 55. 5 HT3-Receptor Blockers use and cautions Zofran- nausea, vomiting, cancer, chemotherapy Causes fetus to develop cleft palate/cleft lip 56. Cautions to take with benzodiazepines- pt safety Very addictive, should be short term, do not mix with alcohol, tired, dizzy 57. Adverse effects with barbiturates Can be used for anxiety, insomnia, seizures Phenylbarbatol- depresses CNS, using it to calm someone down Bradycardic, hypotension, syncope, hallucinations, steven johnson syndrome- severe skin rash starts in oral mucosa 58. Pt teaching with Lunesta Sleep driving or other activites Treatment of insomnia 59. MAoIs and food restrictions Aged cheese, swiss, fermented fishes, beer, caviar, no smoked or pickled meats, soy sauce, pepperoni 60. SSRIs syndrome Selective serotonin reuptake inhibitor Too much serotonin, can have fatal reaction Signs and sympthoms- cardiac, respiratory, high temperature, fever, death 61. Adverse effects of antipsychotic-extrapyramidal side effects A.Dystonia—spasms of the tongue, neck, back, and legs. Spasms may cause unnatural positioning of the neck, abnormal eye movements, excessive salivation. B.Akathisia—continuous restlessness, inability to sit still. Constant moving, foot tapping, hand movements may be seen. C.Pseudoparkinsonism—muscle tremors, cogwheel rigidity, drooling, shuffling gait, slow movements. D.Tardive dyskinesia—abnormal muscle movements such as lip smacking, tongue darting, chewing movements, slow and aimless arm and leg movements. 62. Lithium serum levels Bipolar Serum levels of <1.5 mEq/L: CNS problems, including lethargy, slurred speech, muscle weakness, and fine tremor; polyuria, which relates to renal toxicity; and beginning of gastric toxicity, with nausea, vomiting, and diarrhea Serum levels of 1.5 to 2 mEq/L: Intensification of all of the foregoing reactions, with ECG changes Serum levels of 2 to 2.5 mEq/L: Possible progression of CNS effects to ataxia, clonic movements, hyperreflexia, and seizures; possible CV effects such as severe ECG changes and hypotension; large output of dilute urine secondary to renal toxicity; fatalities secondary to pulmonary toxicity Serum levels >2.5 mEq/L: Complex multiorgan toxicity with a significant risk of death 63. Nursing considerations for Pt receiving Nervous System Stimulants Adderall Cause to lose appetite, take in the morning, assess temperature, reflexes, can cause nervousness, insomnia, tachycardia, abdominal pain 64. Adverse effects of phenytoin Ataxia, slurred speech, confusion, dizziness, tremors 65. Levodopa- therapeutic actions 2-5 years Sometimes take a holiday to make work Treats parkinson disease, precursor to dopamine 66. Baclofen- Pt teaching Centrally acting muscle relaxant, avoid alcohol, no cns depressant drugs, tapered over 1-2 weeks 67. Naloxone- used for and adverse effects Opioid overdose Usually patient has array of diff issues- watch them for a few hours and hydrate slowly, keep up with vitals 68. Midazolam- actions- adverse effects (benzo) Bradycardia, tachycardia, used for sedation, has amnesia before, used for surgery 69. Pt teaching about neuromuscular Junction blocking agents Vecuronium, nondepolarizing one Completely paralyzes and also do not remember it 70. Somatropin- actions and use Used to replace growth hormone in children and adults. Promote growth of muscles and organs 71. Prednisone-use and action Steroid, reduces inflammation, respiratory, allergic reactions, autoimmune issues 72. Levothyroxine- use and adverse effects Can put into hyperthyroidism state, used for hypothyroidism 73. Insulin- Pt teaching and adverse effects Used for diabetics who patients pancreas does not make insulin Rotate site of injection Hyperglycemia- hot and dry sugar high (do not have enough insulin) Hypoglycemia- cold and clammy need some candy (to much insulin)
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